NPIMap

Organization Active NPI

Poudre Valley Medical Group, LLC

Doing business as UCHealth Medical Group

  • Pain Medicine Physician
  • Fort Collins, CO
National Provider Identifier
1720600018
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
POUDRE VALLEY MEDICAL GROUP, LLC
Doing business as
UCHealth Medical Group
Practice address
3744 S Timberline Rd Ste 102
Fort Collins, CO 80525-4334
Phone
(970) 495-0506
Fax
(970) 495-0485
NPI assigned
May 11, 2020
Last updated
Aug 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
POUDRE VALLEY MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Authorized official

Name
Jana Conroy
Title
Director of Credentialing
Phone
(970) 495-0506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X NU Primary

Addresses

Primary practice location

3744 S Timberline Rd Ste 102
Fort Collins, CO 80525-4334

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (970) 495-0506

Other names 2

  • UCHealth Medical Group Doing business as
  • UCHealth Pain Management Clinic - Fort Collins Other name

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
06D2038902Uchealth Pain Management - Fort Collins3744 S Timberline Rd, Fort Collins, CO 80525Certificate of waiverMar 26, 2028

National Provider Directory

National Provider Directory
Tax ID family
Poudre Valley Med GRP LLC283 organizations share this tax ID, including this one
Part of
Poudre Valley Med GRP LLC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1720600018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-495-0506",
            "fax_number": "970-495-0485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3744 S TIMBERLINE RD STE 102",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254334",
            "telephone_number": "970-495-0506",
            "fax_number": "970-495-0485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "enumeration_date": "2020-05-11",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "CONROY",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "970-495-0506"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCHealth Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCHealth Pain Management Clinic - Fort Collins",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.