NPIMap

Organization Active NPI

Optumcare Colorado Medical Group LLC

  • General Practice Physician
  • Colorado Springs, CO
National Provider Identifier
1770524985
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
OPTUMCARE COLORADO MEDICAL GROUP LLC
Practice address
2 S Cascade Ave Ste 140
Colorado Springs, CO 80903-1604
Phone
(719) 463-5600
Fax
(719) 538-2990
NPI assigned
Jun 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Authorized official

Name
Emily Castillo
Title
Associate Director Credentialing
Phone
(702) 579-3253

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X CO Primary

Addresses

Primary practice location

2 S Cascade Ave Ste 140
Colorado Springs, CO 80903-1604

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Other identifiers 2

IdentifierTypeStateIssuer
04740080MedicaidCO
06085288MedicaidCO

Other names 4

  • Optum Colorado Springs Doing business as
  • Colorado Springs Health Partners LLC Former legal business name
  • DaVita Medical Group Colorado Springs LLC Former legal business name
  • OptumCare Colorado Springs LLC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Davita Med GRP Co Springs61 organizations share this tax ID, including this one

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

2 S Cascade Ave
Ste 140
Colorado Springs, CO 80903
Phone (719) 538-2900

5115 Fontaine Blvd
Fountain, CO 80817
Phone (719) 392-2000

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1770524985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203",
            "fax_number": "719-538-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 S CASCADE AVE STE 140",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809031604",
            "telephone_number": "719-463-5600",
            "fax_number": "719-538-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE COLORADO MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR CREDENTIALING",
        "authorized_official_telephone_number": "702-579-3253"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04740080",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06085288",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optum Colorado Springs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colorado Springs Health Partners LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "DaVita Medical Group Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "OptumCare Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.