Individual provider Active NPI

Kelly Brook Lewis, MD

  • Emergency Medicine Physician
  • Grand Junction, CO
National Provider Identifier
1750510400
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DR.0068466 Issued in CO
Practice address
2351 G Rd
Grand Junction, CO 81505-9641
Phone
(970) 242-0920
NPI assigned
Jul 2, 2009
Last updated
Sep 28, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X LL32025 SC
Emergency Medicine Physician 207P00000X DR.0068466 CO Primary

Addresses

Primary practice location

2351 G Rd
Grand Junction, CO 81505-9641

Mailing address

PO Box 1687
Grand Junction, CO 81502-1687
Phone (970) 242-0920

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, CO2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121127000685 TN Practitioner - Emergency Medicine 3375716814 Reassigns benefits to 2 organizations
I20220618000293 CO Practitioner - Emergency Medicine 3375716814 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
LL32025SCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-Cities Observation Services, PC Emergency Medicine CurrentSince Apr 1, 2017 Accepting new patients
Colorado West Healthcare System CurrentSince Jul 1, 2022 Accepting new patients
Colorado West Healthcare System CurrentSince Jul 1, 2022 Accepting new patients
Community Medical Group, LLC Past Accepting new patients

Locations

2351 G Rd
Grand Junction, CO 81505
Phone (970) 242-0920

400 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-1310

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1246492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1750510400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1687",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815021687",
            "telephone_number": "970-242-0920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2351 G RD",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815059641",
            "telephone_number": "970-242-0920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "KELLY",
        "middle_name": "BROOK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-02",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "LL32025",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "DR.0068466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Junction, CO

Sources for this page

Verify at the official NPI Registry.