Advanced Dermatology of Colorado, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ADVANCED DERMATOLOGY OF COLORADO, PC

Practice address

1100 Poudre River Dr Unit a
Fort Collins, CO 80524-3557

Phone

(970) 484-6303

Fax

(970) 484-3036

NPI assigned

Mar 17, 2015

Last updated

Nov 6, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amy Declue

Title

Director-Provider Services

Phone

(407) 875-2080

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 125

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Saad Alsubaie, M.D

  • Plastic Surgery Physician
  • Englewood, CO
  • NPI 1770999112
  Medicare reassignment Care Compare group NPD
• Bret Baack, MD

  • Dermatology Physician
  • Fort Collins, CO
  • NPI 1780690487
  Medicare reassignment Care Compare group NPD
• Alison Marie Bailey, MD

  • Dermatology Physician
  • Loveland, CO
  • NPI 1376002238
  Medicare reassignment Care Compare group NPD
• Roberto A Belli, M.D.

  • Dermatology Physician
  • Englewood, CO
  • NPI 1770879264
  Medicare reassignment Care Compare group NPD
• Lindsey Broussard

  • Dermatology Physician
  • Denver, CO
  • NPI 1679006597
  Medicare reassignment Care Compare group NPD
• Daniel Callaghan III

  • Dermatology Physician
  • Denver, CO
  • NPI 1629496872
  Medicare reassignment Care Compare group NPD
• Leslie R Capin, MD

  • Dermatology Physician
  • Englewood, CO
  • NPI 1881619443
  Medicare reassignment Care Compare group NPD
• Stephen Paul Castle, D.O.

  • Dermatology Physician
  • Greeley, CO
  • NPI 1932217742
  Medicare reassignment Care Compare group NPD
• Marye Margaret Catalano, NP

  • Family Nurse Practitioner
  • Denver, CO
  • NPI 1023587805
  Medicare reassignment Care Compare group NPD
• Kelsey Ferrara Coffran, FNP

  • Family Nurse Practitioner
  • Thornton, CO
  • NPI 1265005532

  Dermatology

  Medicare reassignment Care Compare group NPD
• Carl W Demidovich, M.D.

  • Dermatology Physician
  • Denver, CO
  • NPI 1558463307
  Medicare reassignment Care Compare group NPD
• Richard Thomas Ethridge, MD

  • Plastic and Reconstructive Surgery Physician
  • Fort Collins, CO
  • NPI 1013108299
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1426550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541462400000",
    "number": "1710370648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN",
            "address_2": "SUITE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517176",
            "telephone_number": "407-875-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 POUDRE RIVER DR UNIT A",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805243557",
            "telephone_number": "970-484-6303",
            "fax_number": "970-484-3036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY OF COLORADO, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-17",
        "last_updated": "2018-11-06",
        "status": "A",
        "authorized_official_last_name": "DECLUE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR-PROVIDER SERVICES",
        "authorized_official_telephone_number": "407-875-2080"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Admire Dental of Fort Collins PLLC
• Jacqueline Adolph
• Zuleyka Adorno-Calderon, MS, CCC-SLP
• Adria Rigg, LLC
• Advance Therapy, Inc.
• Advanced Foot Care, PC
• Advanced Health Rehab
• Advanced Healthcare, PLLC
• Advanced Hearing Services, LLC
• Advanced Home Healthcare LLC

• Dermatology Physician in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.