Individual provider Active NPI

Luis Enrique Perez, RN-C

  • Adult Health Nurse Practitioner
  • Colorado Springs, CO
National Provider Identifier
1730143827
Registry record updated Jan 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
696585 Issued in TX
Practice address
9320 Grand Cordera Pkwy
Ste 100
Colorado Springs, CO 80924-7004
Phone
(719) 282-6337
Fax
(719) 282-0532
NPI assigned
Apr 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 696585 TX Primary

Addresses

Primary practice location

9320 Grand Cordera Pkwy
Ste 100
Colorado Springs, CO 80924-7004

Mailing address

12419 Wetterhorn Peak Dr
Peyton, CO 80831-4407
Phone (719) 494-2215

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120501000581 CO Practitioner - Nurse Practitioner 2264694660 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
696585TXMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Family Practice CurrentSince Jan 2, 2018 Accepting new patients

Locations

9320 Grand Cordera Pkwy
Ste 100
Colorado Springs, CO 80924
Phone (719) 282-6337

9320 Grand Cordera Pkwy
#10
Colorado Springs, CO 80924
Phone (719) 282-6337

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516665600000",
    "number": "1730143827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12419 WETTERHORN PEAK DR",
            "city": "PEYTON",
            "state": "CO",
            "postal_code": "808314407",
            "telephone_number": "719-494-2215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9320 GRAND CORDERA PKWY",
            "address_2": "STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809247004",
            "telephone_number": "719-282-6337",
            "fax_number": "719-282-0532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "LUIS",
        "middle_name": "ENRIQUE",
        "credential": "RN-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2018-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "696585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.