Individual provider Active NPI

Michael Lawrence Phillip, PT

  • Physical Therapist
  • Colorado Springs, CO
National Provider Identifier
1811181910
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTL.0012369 Issued in CO
Practice address
600 S 21St St
Suite 120
Colorado Springs, CO 80904-3762
Phone
(719) 634-1110
NPI assigned
Aug 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070015934 IL
Physical Therapist 225100000X PTL.0012369 CO Primary

Addresses

Primary practice location

600 S 21St St
Suite 120
Colorado Springs, CO 80904-3762

Mailing address

830 N Sherman St
#206
Denver, CO 80203-2909
Phone (561) 715-1515

Other identifiers 6

IdentifierTypeStateIssuer
568150OtherILMEDICARE GROUP NUMBER
1619908OtherILBCBS IL GROUP
CD3789OtherILMEDICARE RAILROAD GROUP NUMBER
567700OtherILMEDICARE GROUP NUMBER
P00624023OtherILMEDICARE RAILROAD
568080OtherILMEDICARE GROUP NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140321000853 CO Practitioner - Physical Therapist in Private Practice 0244327484 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTL.0012369COMDPhysical Therapist
070015934ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Panorama Orthopedics and Spine Center PC Current Accepting new patients
Intermountain Medical Group Denver, LLC Current Accepting new patients
Panorama Orthopedics & Spine Center, PC CurrentSince May 13, 2019 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Jul 2, 2024 Accepting new patients
Panorama Orthopedics & Spine Center, PC CurrentSince May 13, 2019 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Jul 2, 2024 Accepting new patients
Colorado Luna Care Physical Therapy LLC Physical Therapist CurrentSince Jul 2, 2024 Accepting new patients

Locations

500 Eldorado Blvd
Bldg 4
Broomfield, CO 80021
Phone (303) 812-4790

1230 Tenderfoot Hill Rd
Ste 155
Colorado Springs, CO 80906
Phone (719) 527-3383

6160 Tutt Blvd
Ste 240
Colorado Springs, CO 80923
Phone (719) 596-0880

3605 Austin Bluffs Pkwy
Colorado Springs, CO 80918
Phone (719) 265-6601

501 S Cherry St
Fl 11
Denver, CO 80246
Phone (309) 530-8782

660 Golden Ridge Rd
Ste 130
Golden, CO 80401
Phone (303) 275-2190

660 Golden Ridge Rd
Ste 250
Golden, CO 80401
Phone (303) 274-7321

1265 Sgt Jon Stiles Dr
Unit D
Highlands Ranch, CO 80129
Phone (303) 274-7332

8550 W 38th Ave
Ste 100
Wheat Ridge, CO 80033
Phone (303) 467-4100

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459209600000",
    "number": "1811181910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 N SHERMAN ST",
            "address_2": "#206",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802032909",
            "telephone_number": "561-715-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S 21ST ST",
            "address_2": "SUITE 120",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809043762",
            "telephone_number": "719-634-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIP",
        "first_name": "MICHAEL",
        "middle_name": "LAWRENCE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-31",
        "last_updated": "2016-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070015934",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0012369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "568150",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IL GROUP",
            "identifier": "1619908",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD GROUP NUMBER",
            "identifier": "CD3789",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "567700",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00624023",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "568080",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Mar 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.