NPIMap

Organization Active NPI

Intermountain Medical Group Denver, LLC

Doing business as Community Foot & Ankle Clinic - DME

  • Foot & Ankle Surgery Podiatrist
  • Thornton, CO
National Provider Identifier
1730533902
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
POD.0000520 Issued in CO
Legal business name
INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
Doing business as
Community Foot & Ankle Clinic - DME
Practice address
9351 Grant St
Ste 490
Thornton, CO 80229-4358
Phone
(303) 451-5271
Fax
(303) 452-4398
NPI assigned
Apr 14, 2016
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Authorized official

Name
Jon McDaniel
Title
VP Finance - MGPS Operations
Phone
(303) 272-0231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X POD.0000520 CO Primary

Addresses

Primary practice location

9351 Grant St
Ste 490
Thornton, CO 80229-4358

Mailing address

9351 Grant St
Ste 490
Thornton, CO 80229-4358
Phone (303) 451-5271

Other names 2

  • Community Foot & Ankle Clinic - DME Doing business as
  • SCLP Community Foot & Ankle Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160414001983 CO DME Supplier - Physician - Podiatry 0840513552 Practice locations: Northglenn, CO

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Sisters of Charity of Leavenworth Health System Inc

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1730533902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9351 GRANT ST",
            "address_2": "STE 490",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802294358",
            "telephone_number": "303-451-5271",
            "fax_number": "303-452-4398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9351 GRANT ST",
            "address_2": "STE 490",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802294358",
            "telephone_number": "303-451-5271",
            "fax_number": "303-452-4398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP DENVER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "enumeration_date": "2016-04-14",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP FINANCE - MGPS OPERATIONS",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CO",
            "license": "POD.0000520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Foot & Ankle Clinic - DME",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SCLP Community Foot & Ankle Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Thornton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.