Judith Yen Lin Colclough, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

200401649 Issued in NC

Practice address

6905 Knightdale Blvd Ste 106
Knightdale, NC 27545-6506

Phone

(919) 261-8760

Fax

(919) 261-8765

NPI assigned

May 18, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC, MA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: judith.colclough@49428401684484.direct.elationemr.com
• Direct secure messaging: jcolclough512553@direct.unc.nchie.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Unc Physicians Network LLC

  • Family Medicine Physician
  • Pittsboro, NC
  • NPI 1750704367
  Medicare reassignment NPD
• Dothouse Health Inc.

  • Community Health Clinic/Center
  • Dorchester, MA
  • NPI 1578514733
  Medicare reassignment NPD
• South Boston Community Health Center

  • Community Health Clinic/Center
  • South Boston, MA
  • NPI 1669447413
  Medicare reassignment NPD
• Unc Physicians Network LLC

  • General Practice Physician
  • Morrisville, NC
  • NPI 1558786830

  Family Medicine

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1700839859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 PERIMETER PARK DR STE 200",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275608442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6905 KNIGHTDALE BLVD STE 106",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275456506",
            "telephone_number": "919-261-8760",
            "fax_number": "919-261-8765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLCLOUGH",
        "first_name": "JUDITH",
        "middle_name": "YEN LIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "3811",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "237887",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200401649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110080968A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcolclough512553@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "6905 Knightdale Blvd Ste 106",
            "city": "Knightdale",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275456506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chozen1 Enterprises Inc
• Jennifer Lynn Clemmens, FNP
• Club Horizon, Inc.
• Adair Nicole Coggins
• Mark Robert Colbert, PHARMD
• Combi9Ed Efforts
• Laura A Combs, MS, RD, LD
• Communication 360 LLC
• Community Angel Foundation
• Community Outreach Intense Family Services, LLC

• Family Medicine Physician in Knightdale, NC
• Providers in Knightdale, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.