Boulder Plastic Surgery Prof LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

BOULDER PLASTIC SURGERY PROF LLC

Practice address

2525 4TH St
Boulder, CO 80304-3966

Phone

(303) 443-3672

NPI assigned

Dec 17, 2020

Last updated

Dec 17, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Pam Garcia

Title

Office Contact

Phone

(303) 443-2277

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Boulder Plastic Surgery Prof LLC

  • Specialist
  • Boulder, CO
  • NPI 1033705926

  O20040302000408

  Same enrollment
• Boulder Plastic Surgery Prof LLC

  • Specialist
  • Boulder, CO
  • NPI 1043251432

  O20040302000408

  Same enrollment
• Boulder Plastic Surgery Prof LLC

  • Specialist
  • Longmont, CO
  • NPI 1114513009

  O20040302000408

  Same enrollment
• Boulder Plastic Surgery Prof LLC

  • Specialist
  • Longmont, CO
  • NPI 1134715022

  O20040302000408

  Same enrollment
• Boulder Plastic Surgery Prof LLC

  • Specialist
  • Louisville, CO
  • NPI 1326634213

  O20040302000408

  Same enrollment
• Boulder Plastic Surgery Prof LLC

  • Specialist
  • Boulder, CO
  • NPI 1497341754

  O20040302000408

  Same enrollment
• Boulder Plastic Surgery Prof LLC

  • Specialist
  • Westminster, CO
  • NPI 1588250476

  O20040302000408

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1608163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608163200000",
    "number": "1770179335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7643",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805370643",
            "telephone_number": "970-663-2742",
            "fax_number": "970-342-2093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 4TH ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043966",
            "telephone_number": "303-443-3672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER PLASTIC SURGERY PROF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-17",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "OFFICE CONTACT",
        "authorized_official_telephone_number": "303-443-2277"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Boulder, CO
• Providers in Boulder, CO by specialty
• Specialist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; 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.