NPIMap

Organization Active NPI

Provident Senior Health, Inc.

  • Internal Medicine Physician
  • Englewood, CO
National Provider Identifier
1780640169
Registry record updated Aug 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PROVIDENT SENIOR HEALTH, INC.
Practice address
799 E Hampden Ave
Suite 300
Englewood, CO 80113-2700
Phone
(303) 493-5270
Fax
(303) 493-5295
NPI assigned
Apr 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2013

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

Authorized official

Name
Bill Nooning
Title
Ceo
Phone
(303) 493-5270

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

799 E Hampden Ave
Suite 300
Englewood, CO 80113-2700

Mailing address

PO Box 60
Englewood, CO 80151-0060
Phone (303) 493-5270

Other identifiers 1

IdentifierTypeStateIssuer
25175025MedicaidCO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376870400000",
    "number": "1780640169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801510060",
            "telephone_number": "303-493-5270",
            "fax_number": "303-493-5295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "799 E HAMPDEN AVE",
            "address_2": "SUITE 300",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801132700",
            "telephone_number": "303-493-5270",
            "fax_number": "303-493-5295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT SENIOR HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2013-08-19",
        "status": "A",
        "authorized_official_last_name": "NOONING",
        "authorized_official_first_name": "BILL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "303-493-5270"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25175025",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; 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.