NPIMap

Organization Active NPI

Stride Prosthetics LLC

Doing business as Stride Prosthetics

  • Prosthetic/Orthotic Supplier
  • Pueblo, CO
National Provider Identifier
1790381994
Registry record updated Dec 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
STRIDE PROSTHETICS LLC
Doing business as
Stride Prosthetics
Practice address
301 N Main St Ste 110
Pueblo, CO 81003-3257
Phone
(719) 581-7399
Fax
(888) 508-6271
NPI assigned
Dec 11, 2020
Last updated
Dec 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2020

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

Authorized official

Name
Nicholas Wheeler, BOCP, LP
Title
Ceo
Phone
(606) 585-4996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

301 N Main St Ste 110
Pueblo, CO 81003-3257

Mailing address

PO Box 611
Flatwoods, KY 41139-0611

Other names 1

  • STRIDE PROSTHETICS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210430002175 CO DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 6103192398 Practice locations: Pueblo, CO

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Stride Prosthetics Colorado301 N Main St, Pueblo, CO 81003-3257(719) 581-7399 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom Accepts assignmentParticipating since Jul 3, 2017

National Provider Directory

National Provider Directory
Tax ID family
Stride Prosthetics3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1790381994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 611",
            "city": "FLATWOODS",
            "state": "KY",
            "postal_code": "411390611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N MAIN ST STE 110",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033257",
            "telephone_number": "719-581-7399",
            "fax_number": "888-508-6271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STRIDE PROSTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-11",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-585-4996",
        "authorized_official_credential": "BOCP, LP"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STRIDE PROSTHETICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.