Individual provider Active NPI

Edward Jordan Stoll Jr., M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Wheat Ridge, CO
National Provider Identifier
1841201217
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
30560 Issued in CO
Practice address
3455 Lutheran Pkwy Ste 105
Wheat Ridge, CO 80033-6028
Phone
(303) 665-2603
Fax
(303) 665-2605
NPI assigned
Aug 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 30560 CO Primary

Addresses

Primary practice location

3455 Lutheran Pkwy Ste 105
Wheat Ridge, CO 80033-6028

Mailing address

3455 Lutheran Pkwy
Ste 105
Wheat Ridge, CO 80033-6028
Phone (303) 665-2603

Other practice location 1

500 W 144th Ave Ste 230
Westminster, CO 80023-9328
Phone (303) 665-2603 ext. 223

Other identifiers 1

IdentifierTypeStateIssuer
01305606MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050318000542 CO Practitioner - Orthopedic Surgery 8022916998 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30560COMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Centers of Colorado, LLC Sports Medicine CurrentSince Sep 1, 2019 Accepting new patients
Orthopedic Centers of Colorado, LLC Sports Medicine CurrentSince Sep 1, 2019 Accepting new patients
Orthopedic Professional Association P.C. PastSince Jun 12, 2022 Accepting new patients

Locations

1411 S Potomac St
Ste 350
Aurora, CO 80012
Phone (303) 671-2134

8101 E Lowry Blvd
Ste 120
Lowry, CO 80230
Phone (303) 806-1998

500 W 144th Ave
Ste 230
Westminster, CO 80023
Phone 3036652603 ext. 223

3455 Lutheran Pkwy
Ste 210
Wheat Ridge, CO 80033
Phone (303) 403-6580

3455 Lutheran Pkwy
Ste 105
Wheat Ridge, CO 80033
Phone (303) 456-6000

Organizations & group practices 3

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": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1841201217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 LUTHERAN PKWY",
            "address_2": "STE 105",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336028",
            "telephone_number": "303-665-2603",
            "fax_number": "303-665-2605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 LUTHERAN PKWY STE 105",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336028",
            "telephone_number": "303-665-2603",
            "fax_number": "303-665-2605"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 W 144th Ave Ste 230",
            "address_purpose": "LOCATION",
            "city": "Westminster",
            "state": "CO",
            "postal_code": "800239328",
            "country_code": "US",
            "telephone_number": "303-665-2603 x223",
            "fax_number": "303-665-2605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOLL",
        "first_name": "EDWARD",
        "middle_name": "JORDAN",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CO",
            "license": "30560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01305606",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheat Ridge, CO

Sources for this page

Verify at the official NPI Registry.