Lee Michael Fonseca, NP-C
Individual provider Active NPI Nurse Practitioner · Pueblo, CO
NPI 1831258367 · NPPES record last updated Feb 11, 2025
Key facts
- NPI
- 1831258367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- APN.0004081-NP (CO)
- Practice address
- 4112 Outlook Blvd
Suite 37
Pueblo, CO 81008-1667 - Phone
- (719) 562-6254
- Fax
- (719) 562-6255
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Catholic Health Initiatives Colorado
Practice addresses (Care Compare)
4112 Outlook Blvd
Pueblo, CO 81008-1667
Phone (719) 562-6254
Hospital & facility affiliations
- St Mary-Corwin Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050407000520 | CO | Practitioner - Nurse Practitioner | 8527015908 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APN.0004081-NP | CO | MD | Nurse Practitioner |
| 105831 | CO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Intermountain Medical Group Denver, LLC | Current |
Accepting new patients | |
| Catholic Health Initiatives Colorado | Current |
Accepting new patients | |
| Intermountain Medical Group Denver, LLC | Current | Accepting new patients | |
| Catholic Health Initiatives Colorado | Current |
Accepting new patients | |
| Intermountain Medical Group Denver, LLC | Current |
Accepting new patients | |
| Catholic Health Initiatives Colorado | Current | Accepting new patients |
Locations
614 Yale Pl
Canon City, CO 81212
Phone (719) 275-4151
340 Exempla Cir
Ste 300
Lafayette, CO 80026
Phone (303) 673-1390
1008 Minnequa Ave
#1501
Pueblo, CO 81004
Phone (719) 564-0390
4112 Outlook Blvd
Ste 37
Pueblo, CO 81008
Phone (719) 562-6254
1925 E Orman Ave
Ste 440
Pueblo, CO 81004
Phone (719) 557-4744
4112 Outlook Blvd
Pueblo, CO 81008
Phone (719) 553-1000
41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 105831 | CO | |
| Nurse Practitioner | 363L00000X | APN.0004081-NP | CO | Yes |
Addresses
Primary practice location
4112 Outlook Blvd
Suite 37
Pueblo, CO 81008-1667
Mailing address
PO Box 800022 Suite 37
Kansas City, MO 64180-0022
Phone (800) 953-0103
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 92354378 | Medicaid | CO |
Other providers in Pueblo, CO
- Monica A Flynn
- Paula Flynn
- Randall Flynt
- Kati Jo Foechterle
- Chandler Follett
- Joan Lee Fontaine
- For the Love of Me
- Jennifer E Forte
- Michael Forte
- Jessica Leigh Foster
All providers in Pueblo, CO · Nurse Practitioner in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.