NPIMap

Individual provider Active NPI

Herbert Daniel Fahrenholtz, MD

  • Family Medicine Physician
  • Greeley, CO
National Provider Identifier
1811986169
Registry record updated Jul 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR32319 Issued in CO
Practice address
1600 23Rd Ave
Greeley, CO 80634-6070
Phone
(970) 356-2424
Fax
(970) 346-2828
NPI assigned
Oct 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DR32319 CO Primary

Addresses

Primary practice location

1600 23Rd Ave
Greeley, CO 80634-6070

Mailing address

1600 23Rd Ave
Greeley, CO 80634-6070
Phone (970) 356-2424

Other identifiers 1

IdentifierTypeStateIssuer
01323195MedicaidCO

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
I20101202000629 CO Practitioner - Family Practice 4486840469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Colorado Family MedicineGroup PAC ID 0941282271, 22 clinicians

Practice addresses (Care Compare)

1600 23Rd Ave
Greeley, CO 80634-6070
Phone (970) 810-2424

Hospital & facility affiliations

  • Banner North Colorado Medical Center Hospital, Greeley, CO, CCN 060001

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR32319COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Colorado Family Medicine CurrentSince Jul 1, 1974 Accepting new patients
North Colorado Medical Center Past Accepting new patients

Locations

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

1600 23rd Ave
Greeley, CO 80634
Phone (970) 356-2424

Organizations & group practices 2

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 12

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

NPI Registry JSON

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217289600000",
    "number": "1811986169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 23RD AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346070",
            "telephone_number": "970-356-2424",
            "fax_number": "970-346-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 23RD AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346070",
            "telephone_number": "970-356-2424",
            "fax_number": "970-346-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHRENHOLTZ",
        "first_name": "HERBERT",
        "middle_name": "DANIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2008-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR32319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01323195",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

Verify at the official NPI Registry.