NPIMap

Individual provider Active NPI

Michael Thomas Fackler

  • Internal Medicine Physician
  • Pueblo, CO
National Provider Identifier
1770943508
Registry record updated Jun 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR.0062301 Issued in CO
Practice address
400 W 16TH St
Pueblo, CO 81003-2745
Phone
(719) 584-4921
Fax
(719) 595-7994
NPI assigned
Mar 7, 2016
Last updated
Jun 19, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X DR.0062301 CO Primary

Addresses

Primary practice location

400 W 16TH St
Pueblo, CO 81003-2745

Mailing address

PO Box 560825
Denver, CO 80256-0825
Phone (719) 595-7580

Other practice location 1

15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone (586) 263-2300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190809000161 CO Practitioner - Hospitalist 7416249537 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Colorado Hospitalists Professional LLCGroup PAC ID 8325147507, 85 clinicians

Practice addresses (Care Compare)

1024 S Lemay Ave
Poudre Valley Hospital
Fort Collins, CO 80524-3929
Phone (970) 495-7142

2500 Rocky Mountain Ave
Loveland, CO 80538-9004
Phone (970) 624-2500

6767 29TH St
Greeley, CO 80634-5474
Phone (970) 495-7153

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.23 of 100Reported as group
Quality
87
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0062301COMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pathways Hospice Internal Medicine Current Accepting new patients
Pathways Hospice Internal Medicine CurrentSince Aug 22, 2023 Accepting new patients
Northern Colorado Hospitalists Professional LLC CurrentSince Sep 1, 2022 Accepting new patients
Pathways Hospice CurrentSince Aug 22, 2023 Accepting new patients
Medical Center of the Rockies Past Accepting new patients
Poudre Valley Health Care Inc. Past Accepting new patients
Uchealth Greeley Hospital Past Accepting new patients

Locations

8289 E Lowry Blvd
Denver, CO 80230
Phone (303) 321-2828

1024 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 495-7000

2637 Midpoint Dr
Ste F
Fort Collins, CO 80525

305 Carpenter Rd
Fort Collins, CO 80525
Phone (970) 663-3500

317 Carpenter Rd
Fort Collins, CO 80525
Phone (970) 663-3500

2500 Rocky Mountain Ave
Loveland, CO 80538
Phone (970) 297-6425

Organizations & group practices 7

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.

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1457308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560902400000",
    "number": "1770943508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 560825",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802560825",
            "telephone_number": "719-595-7580",
            "fax_number": "719-545-0176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032745",
            "telephone_number": "719-584-4921",
            "fax_number": "719-595-7994"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15855 19 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Clinton Township",
            "state": "MI",
            "postal_code": "480383504",
            "country_code": "US",
            "telephone_number": "586-263-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FACKLER",
        "first_name": "MICHAEL",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-07",
        "last_updated": "2019-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0062301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.