NPIMap

Individual provider Active NPI

Christa Maria Coolidge

  • Adult Health Nurse Practitioner
  • Colorado Springs, CO
National Provider Identifier
1730199365
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APN.0005006-NP Issued in CO
Practice address
2767 Janitell Rd
Colorado Springs, CO 80906-4102
Phone
(719) 365-2888
NPI assigned
Aug 8, 2006
Last updated
May 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APN.0005006-NP CO
Adult Health Nurse Practitioner 363LA2200X APN.0005006-NP CO Primary
Registered Nurse 163W00000X RN.0125853 CO

Addresses

Primary practice location

2767 Janitell Rd
Colorado Springs, CO 80906-4102

Mailing address

2767 Janitell Rd
Colorado Springs, CO 80906-4102
Phone (719) 365-2888

Other identifiers 1

IdentifierTypeStateIssuer
41586000MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110907001118 CO Practitioner - Nurse Practitioner 6406026152 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

2767 Janitell Rd
Colorado Springs, CO 80906-4102
Phone (719) 365-2888

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN.0125853COMDRegistered Nurse
APN.0005006-NPCOMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Oct 17, 2016 Accepting new patients
True North Health Navigation LLC CurrentSince Feb 1, 2019 Accepting new patients
Poudre Valley Medical Group, LLC Past Accepting new patients

Locations

1035 Garden of the Gods Rd
Ste 120
Colorado Springs, CO 80907
Phone (719) 329-1000

13445 Voyager Pkwy
Colorado Springs, CO 80921
Phone (719) 219-0333

2767 Janitell Rd
Colorado Springs, CO 80906
Phone (719) 365-2888

4323 Integrity Center Pt
Colorado Springs, CO 80917
Phone (719) 591-2558

5825 Delmonico Dr
Ste 101
Colorado Springs, CO 80919
Phone (706) 315-2523

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

11605 Meridian Market Vw
Ste 184
Peyton, CO 80831
Phone (719) 364-9555

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1730199365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2767 JANITELL RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064102",
            "telephone_number": "719-365-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2767 JANITELL RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064102",
            "telephone_number": "719-365-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLIDGE",
        "first_name": "CHRISTA",
        "middle_name": "MARIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "APN.0005006-NP",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CO",
            "license": "APN.0005006-NP",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "RN.0125853",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41586000",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.