NPIMap

Organization Active NPI

Advanced Ear, Nose & Throat, PC

  • Otolaryngology Physician
  • Greenwood Village, CO
National Provider Identifier
1710065446
Registry record updated Aug 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
31645 Issued in CO
Legal business name
ADVANCED EAR, NOSE & THROAT, PC
Practice address
7400 E Crestline Cir
Suite 100
Greenwood Village, CO 80111-3656
Phone
(303) 792-3242
Fax
(303) 792-9403
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2014

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

Authorized official

Name
Dr. Michael R Menachof, MDNPI 1396871265
Title
Owner
Phone
(303) 792-3242

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 31645 CO Primary

Addresses

Primary practice location

7400 E Crestline Cir
Suite 100
Greenwood Village, CO 80111-3656

Mailing address

7400 E Crestline Cir
Suite 100
Greenwood Village, CO 80111-3656
Phone (303) 792-3242

Other identifiers 5

IdentifierTypeStateIssuer
01316454MedicaidCO
1275724932OtherNPI
1396871265OtherCONPI
48138274MedicaidCO
1710065446OtherCONPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040330001749 CO Part B Supplier - Clinic/Group Practice 4183616352 Receives reassigned benefits from 5 practitioners
Practice locations: Greenwood Village, CO

National Provider Directory

National Provider Directory

Locations

125 Inverness Dr E
Ste 330
Englewood, CO 80112
Phone (303) 799-1443

7400 E Crestline Cir
Ste 100
Greenwood Village, CO 80111
Phone (303) 770-4227

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406851200000",
    "number": "1710065446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 E CRESTLINE CIR",
            "address_2": "SUITE 100",
            "city": "GREENWOOD VILLAGE",
            "state": "CO",
            "postal_code": "801113656",
            "telephone_number": "303-792-3242",
            "fax_number": "303-792-9403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 E CRESTLINE CIR",
            "address_2": "SUITE 100",
            "city": "GREENWOOD VILLAGE",
            "state": "CO",
            "postal_code": "801113656",
            "telephone_number": "303-792-3242",
            "fax_number": "303-792-9403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED EAR, NOSE & THROAT, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2014-08-01",
        "status": "A",
        "authorized_official_last_name": "MENACHOF",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-792-3242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "CO",
            "license": "31645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01316454",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1275724932",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1396871265",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48138274",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1710065446",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood Village, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.