NPIMap

Organization Active NPI

Rocky Mountain Primary Care Clinic

  • Family Nurse Practitioner
  • Pueblo, CO
National Provider Identifier
1720385016
Registry record updated Mar 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
65214 Issued in CO
Legal business name
ROCKY MOUNTAIN PRIMARY CARE CLINIC
Practice address
131 S Main St
Suite 101
Pueblo, CO 81003-3415
Phone
(719) 924-9398
Fax
(719) 924-9593
NPI assigned
Feb 22, 2011
Last updated
Mar 8, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2017

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

Authorized official

Name
Mrs. Ashley N. Kirby, FNP-CNPI 1427235423
Title
Nurse Practitioner/Owner
Phone
(719) 924-9398

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X 65214 CO Primary
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X CO
Primary Care Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP2300X CO

Addresses

Primary practice location

131 S Main St
Suite 101
Pueblo, CO 81003-3415

Mailing address

131 S Main St
Suite 101
Pueblo, CO 81003-3415
Phone (719) 924-9398

Other identifiers 1

IdentifierTypeStateIssuer
45256781MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110721000455 CO Part B Supplier - Clinic/Group Practice 6103094974 Receives reassigned benefits from 12 practitioners
Practice locations: Pueblo, CO

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2025909Rocky Mountain Primary Care Clinic131 South Main St, Pueblo, CO 81003Certificate of waiverJun 20, 2027

National Provider Directory

National Provider Directory

Locations

131 S Main St
Ste 101
Pueblo, CO 81003
Phone (719) 924-9398

131 S Main St
Pueblo, CO 81003
Phone (719) 924-9398

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1298332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488931200000",
    "number": "1720385016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 S MAIN ST",
            "address_2": "SUITE 101",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033415",
            "telephone_number": "719-924-9398",
            "fax_number": "719-924-9593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 S MAIN ST",
            "address_2": "SUITE 101",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033415",
            "telephone_number": "719-924-9398",
            "fax_number": "719-924-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKY MOUNTAIN PRIMARY CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-22",
        "last_updated": "2017-03-08",
        "status": "A",
        "authorized_official_last_name": "KIRBY",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "719-924-9398",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "65214",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45256781",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2017; 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.