Organization Active NPI

Banner Health Physicians Colorado LLC

  • Multi-Specialty Clinic/Center
  • Loveland, CO
National Provider Identifier
1851652192
Registry record updated Jun 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
BANNER HEALTH PHYSICIANS COLORADO LLC
Practice address
1647 E 18TH St
Loveland, CO 80538-4209
Phone
(970) 663-9523
NPI assigned
Jun 4, 2012
Organization subpart
Yes
Parent organization
BANNER MEDICAL GROUP COLORADOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2012

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

Authorized official

Name
Dennis Dahlen
Title
Sr VP Finance
Phone
(602) 747-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

1647 E 18TH St
Loveland, CO 80538-4209

Mailing address

1441 N 12TH St
Phoenix, AZ 85006-2837

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111219000237 CO Part B Supplier - Clinic/Group Practice 8921273038 Receives reassigned benefits from 380 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Loveland, CO; Yuma, CO; Sterling, CO; Timnath, CO; Wellington, CO; Windsor, CO; Wray, CO; Fort Collins, CO…

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1338768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338768000000",
    "number": "1851652192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 N 12TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1647 E 18TH ST",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805384209",
            "telephone_number": "970-663-9523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER HEALTH PHYSICIANS COLORADO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER MEDICAL GROUP COLORADO",
        "enumeration_date": "2012-06-04",
        "last_updated": "2012-06-04",
        "status": "A",
        "authorized_official_last_name": "DAHLEN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "SR VP FINANCE",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; 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.