NPIMap

Organization Active NPI

Lutheran Hospital Association of the San Luis Valley

Doing business as SLV Regional Medical Center

  • Surgery Physician
  • Del Norte, CO
National Provider Identifier
1851579262
Registry record updated Feb 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
Doing business as
SLV Regional Medical Center
Practice address
310 County Road 14
Del Norte, CO 81132-8719
Phone
(719) 657-2510
Fax
(719) 587-1372
NPI assigned
Feb 7, 2008
Last updated
Feb 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2008

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

Authorized official

Name
Russell W. Johnson, C.E.O.
Title
Chief Executive Officer
Phone
(719) 589-2511

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Obstetrics & Gynecology Physician 207V00000X
Orthopaedic Surgery Physician 207X00000X
Pediatrics Physician 208000000X
Physical Medicine & Rehabilitation Physician 208100000X
Surgery Physician 208600000X Primary

Addresses

Primary practice location

310 County Road 14
Del Norte, CO 81132-8719

Mailing address

106 Blanca Ave
Alamosa, CO 81101-2340
Phone (719) 589-3000

Other identifiers 1

IdentifierTypeStateIssuer
68085770MedicaidCO

Other names 1

  • SLV Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031201000318 CO Part B Supplier - Clinic/Group Practice 4789589094 Receives reassigned benefits from 230 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alamosa, CO; Monte Vista, CO; La Jara, CO; Del Norte, CO

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Slvrmc Prof Comp11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202342400000",
    "number": "1851579262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 BLANCA AVE",
            "city": "ALAMOSA",
            "state": "CO",
            "postal_code": "811012340",
            "telephone_number": "719-589-3000",
            "fax_number": "719-587-1372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 COUNTY ROAD 14",
            "city": "DEL NORTE",
            "state": "CO",
            "postal_code": "811328719",
            "telephone_number": "719-657-2510",
            "fax_number": "719-587-1372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-07",
        "last_updated": "2008-02-07",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "719-589-2511",
        "authorized_official_credential": "C.E.O."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "68085770",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SLV Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Del Norte, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2008; 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.