NPIMap

Individual provider Active NPI

Kristin L Kruse, MD

  • Obstetrics & Gynecology Physician
  • Pueblo, CO
National Provider Identifier
1861487563
Registry record updated Jun 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
39497 Issued in CO
Practice address
1501 Court St
Pueblo, CO 81003-2720
Phone
(719) 543-6755
Fax
(719) 583-2236
NPI assigned
Sep 19, 2005
Last updated
Jun 11, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 39497 CO Primary

Addresses

Primary practice location

1501 Court St
Pueblo, CO 81003-2720

Mailing address

1120 Minnequa Ave
Pueblo, CO 81004-3734
Phone (719) 564-0660

Other identifiers 1

IdentifierTypeStateIssuer
90389344MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100526000531 CO Practitioner - Obstetrics/Gynecology 5698862316 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Creighton University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

4010 Jerry Murphy Rd
Pueblo, CO 81001-1045
Phone (719) 562-2021

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39497COMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jun 1, 2025 Accepting new patients
Poudre Valley Medical Group, LLC Obstetrics & Gynecology CurrentSince Jun 1, 2025 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

1008 Minnequa Ave
Pueblo, CO 81004
Phone (719) 557-5656

1120 Minnequa Ave
Pueblo, CO 81004
Phone (719) 281-3285

1501 Court St
Pueblo, CO 81003
Phone (719) 543-6755

1600 N Grand Ave
Ste 400
Pueblo, CO 81003
Phone (719) 543-4000

1619 N Greenwood St
Ste 106
Pueblo, CO 81003
Phone (719) 595-7760

4010 Jerry Murphy Rd
Pueblo, CO 81001
Phone (719) 546-2229

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1861487563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 MINNEQUA AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043734",
            "telephone_number": "719-564-0660",
            "fax_number": "719-564-0037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 COURT ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032720",
            "telephone_number": "719-543-6755",
            "fax_number": "719-583-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUSE",
        "first_name": "KRISTIN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-19",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CO",
            "license": "39497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90389344",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.