Active NPI
Kelly Wade Tucker, MD
- Family Medicine Physician
- Greeley, CO
National Provider Identifier
1871568782
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(4) exclusion effective Mar 18, 2010.
- Section 1128a(2) exclusion effective Nov 19, 2009.
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 32537
- Practice address
- 2520 W 16TH St
Greeley, CO 80634-4902 - Phone
- (970) 356-2520
- Fax
- (970) 356-6928
- NPI assigned
- Feb 22, 2006
- Last updated
- Oct 18, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 32537 | CO | Primary |
Addresses
Primary practice location
2520 W 16TH St
Greeley, CO 80634-4902
Mailing address
6801 W 20TH St
Suite 101
Greeley, CO 80634
Phone (970) 378-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01325372 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32537 | CO | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192665600000",
"number": "1871568782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6801 W 20TH ST",
"address_2": "SUITE 101",
"city": "GREELEY",
"state": "CO",
"postal_code": "80634",
"telephone_number": "970-378-8000",
"fax_number": "970-378-8088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2520 W 16TH ST",
"city": "GREELEY",
"state": "CO",
"postal_code": "806344902",
"telephone_number": "970-356-2520",
"fax_number": "970-356-6928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKER",
"first_name": "KELLY",
"middle_name": "WADE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-22",
"last_updated": "2007-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "32537",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01325372",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greeley, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.