NPIMap

Organization Active NPI

Intermountain Medical Group Denver, LLC

  • Family Medicine Physician
  • Lakewood, CO
National Provider Identifier
1730919085
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
Practice address
360 S Teller St Ste 200
Lakewood, CO 80226-7384
Phone
(303) 403-6600
NPI assigned
Aug 2, 2024
Organization subpart
Yes
Parent organization
INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 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
Phone
(303) 272-0231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

360 S Teller St Ste 200
Lakewood, CO 80226-7384

Mailing address

500 Eldorado Blvd Ste 4300
Broomfield, CO 80021-3564
Phone (303) 272-0566

Other names 1

  • Belmar Clinic - Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150106000131 CO Part B Supplier - Clinic/Group Practice 0840513552 Receives reassigned benefits from 1,361 practitioners
This NPI is an additional NPI on the enrollment

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
06D0514395Belmar Clinic - Primary Care360 S Teller St, Suite 200, Lakewood, CO 80226Certificate of waiverJan 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Intermountain Medical Group Denver LLC121 organizations share this tax ID, including this one
Part of
Lutheran Medical Center

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

Locations

360 S Teller St
Lakewood, CO 80226

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1722556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1730919085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ELDORADO BLVD STE 4300",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800213564",
            "telephone_number": "303-272-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 S TELLER ST STE 200",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802267384",
            "telephone_number": "303-403-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP DENVER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "enumeration_date": "2024-08-02",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Belmar Clinic - Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Belmar Clinic - Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.