NPIMap

Organization Active NPI

Retina Consultants of Southern Colorado P C

  • Ophthalmology Physician
  • Colorado Springs, CO
National Provider Identifier
1831714237
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
RETINA CONSULTANTS OF SOUTHERN COLORADO P C
Practice address
10035 Pearl Pass View
Suite 110
Colorado Springs, CO 80924
Phone
(719) 473-9595
Fax
(719) 227-0669
NPI assigned
Jun 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

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

Authorized official

Name
Chrissy Beal
Title
Front Office Manager
Phone
(719) 473-9595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

10035 Pearl Pass View
Suite 110
Colorado Springs, CO 80924

Mailing address

10035 Pearl Pass View
Suite 110
Colorado Springs, CO 80924
Phone (719) 473-9595

Other identifiers 6

IdentifierTypeStateIssuer
9000173749MedicaidCO
1013250240MedicaidCO
93008716MedicaidCO
67174787MedicaidCO
97656372MedicaidCO
9000181814MedicaidCO

Other names 1

  • Retina Consultants Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323000148 CO Part B Supplier - Clinic/Group Practice 8123914694 Receives reassigned benefits from 8 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Colorado Springs, CO; Pueblo, CO

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Retina Consultants of Southern Colorado P C3 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.

Locations

10035 Pearl Pass Vw
Ste 110
Colorado Springs, CO 80924
Phone (719) 473-9595

2770 N Union Blvd
Ste 140
Colorado Springs, CO 80909
Phone (719) 473-9595

3711 Parker Blvd
Pueblo, CO 81008
Phone (719) 473-9595

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1831714237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10035 PEARL PASS VIEW",
            "address_2": "SUITE 110",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80924",
            "telephone_number": "719-473-9595",
            "fax_number": "719-227-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10035 PEARL PASS VIEW",
            "address_2": "SUITE 110",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80924",
            "telephone_number": "719-473-9595",
            "fax_number": "719-227-0669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA CONSULTANTS OF SOUTHERN COLORADO P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-11",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A",
        "authorized_official_last_name": "BEAL",
        "authorized_official_first_name": "CHRISSY",
        "authorized_official_title_or_position": "FRONT OFFICE MANAGER",
        "authorized_official_telephone_number": "719-473-9595"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000173749",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013250240",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "93008716",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "67174787",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "97656372",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000181814",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Retina Consultants",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jun 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.