NPIMap

Individual provider Active NPI

Joseph John Nissim, MD

  • Internal Medicine Physician
  • Longmont, CO
National Provider Identifier
1780765024
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR.0027222 Issued in CO
Practice address
2101 Ken Pratt Blvd Ste 104
Longmont, CO 80501-6568
Phone
(303) 415-4157
Fax
(303) 776-3109
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DR.0027222 CO Primary

Addresses

Primary practice location

2101 Ken Pratt Blvd Ste 104
Longmont, CO 80501-6568

Mailing address

5450 Western Ave
Suite B
Boulder, CO 80301-2709
Phone (303) 415-4157

Other identifiers 2

IdentifierTypeStateIssuer
04005930MedicaidCO
P00987579OtherCOMEDICARE RAILROAD

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
I20100802000433 CO Practitioner - Internal Medicine 0143239053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rush Medical College of Rush University, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

2101 Ken Pratt Blvd
Suite 104a
Longmont, CO 80501-6568
Phone (303) 415-4155

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0027222COMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Jun 1, 2011 Accepting new patients
Boulder Community Health Current Accepting new patients
Boulder Community Health CurrentSince Jun 1, 2011 Accepting new patients
Boulder Community Health Past Accepting new patients
Frontier Internal Medicine PC Internal Medicine PastSince Jul 1, 1987 Accepting new patients

Locations

4747 Arapahoe Ave
Boulder, CO 80303
Phone (303) 415-7000

1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450

5450 Western Ave
Ste B
Boulder, CO 80301

2101 Ken Pratt Blvd
Ste 104A
Longmont, CO 80501
Phone (303) 415-4155

2101 Ken Pratt Blvd
Ste 104
Longmont, CO 80501
Phone (303) 776-1532

2030 Mountain View Ave
Ste 400
Longmont, CO 80501
Phone (303) 776-1532

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 and National Provider Directory roles.

Hospital & facility affiliations 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1780765024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 WESTERN AVE",
            "address_2": "SUITE B",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012709",
            "telephone_number": "303-415-4157",
            "fax_number": "303-776-3109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 KEN PRATT BLVD STE 104",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016568",
            "telephone_number": "303-415-4157",
            "fax_number": "303-776-3109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSIM",
        "first_name": "JOSEPH",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0027222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04005930",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00987579",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.