Potomac Square Family Medicine, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

POTOMAC SQUARE FAMILY MEDICINE, LLC

Practice address

4800 Baseline Rd Ste D106
Boulder, CO 80303-2643

Phone

(303) 499-0176

NPI assigned

Jul 28, 2020

Last updated

Apr 14, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephanie Gluchacki

Title

SVP, Compliance

Phone

(508) 689-9706

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649894400000",
    "number": "1861001554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 173848",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802173848",
            "telephone_number": "303-945-3299",
            "fax_number": "303-945-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 BASELINE RD STE D106",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803032643",
            "telephone_number": "303-499-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC SQUARE FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-28",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A",
        "authorized_official_last_name": "GLUCHACKI",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "SVP, COMPLIANCE",
        "authorized_official_telephone_number": "508-689-9706"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18903312",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Alexander Post, LPC
• Jordon Post, MD
• Paula Postma, O.D.
• Sarah Poston, FNP
• Armand Potestio, RPH
• Jolene Potter, DPT
• Traci Potterf, PHD
• Poudre Valley Medical Group, LLC (UCHealth Medical Group)
• Alison Pouliot, MS OTR/L
• Kenneth Poulsen, DDS

• Primary Care Clinic/Center in Boulder, CO
• Providers in Boulder, CO by specialty
• Primary Care Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.