Prairie Clinic LLC
Organization Active NPI Primary Care Clinic/Center · Springfield, CO
NPI 1740992676 · NPPES record last updated Jun 20, 2025
Key facts
- NPI
- 1740992676
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- PRAIRIE CLINIC LLC
- Practice address
- 172 West 1St
Springfield, CO 81073-8107 - Phone
- (719) 691-4488
- NPI assigned
- Dec 22, 2022
- Organization subpart
- No
Authorized official
- Name
- Tennille Ann Rau, FNP-C
- Title
- LLC Member/Medical Provider
- Phone
- (719) 691-4642
Practitioners 2
-
Jenna Homsher, FNP-BC
-
Tennille Rau, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D2291005 | Prairie Clinic LLC | Certificate of waiver | Oct 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231115003925 | CO | Part B Supplier - Clinic/Group Practice | 5698122455 |
Receives reassigned benefits from 2 practitioners Practice locations: Springfield, CO |
National Provider Directory
Locations
172 W 1st Ave
Springfield, CO 81073
Phone (719) 691-4488
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
172 West 1St
Springfield, CO 81073-8107
Mailing address
172 West 1St
Springfield, CO 81073-9716
Phone (719) 691-4488
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114384138 | Other | CO | NPI 1 |
Other providers in Springfield, CO
- Kyle L Lasley
- Antonio S Manalo
- Cynthia Lynn Packard
- Jacia Dawn Piper
- Poudre Valley Medical Group, LLC
- R & R Family Pharmacy LLC
- Ann Alea Ratliff
- Tennille Rau
- Aubtin Saedi
- Colten Smouse
All providers in Springfield, CO · Primary Care Clinic/Center in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.