NPIMap

Individual provider Active NPI

Bryan T Nolt, M.D.

  • Diagnostic Radiology Physician
  • Pueblo, CO
National Provider Identifier
1881640688
Registry record updated Apr 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
41232 Issued in CO
Practice address
1619 N Greenwood St
Suite 103
Pueblo, CO 81003-2644
Phone
(719) 542-2167
Fax
(719) 542-0320
NPI assigned
May 25, 2006
Last updated
Apr 17, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 41232 CO Primary
Diagnostic Ultrasound Physician 2085U0001X 41232 CO

Addresses

Primary practice location

1619 N Greenwood St
Suite 103
Pueblo, CO 81003-2644

Mailing address

PO Box 11512
Pueblo, CO 81001-0512
Phone (719) 542-2167

Other identifiers 1

IdentifierTypeStateIssuer
61623334MedicaidCO

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
I20120314000347 CO Practitioner - Diagnostic Radiology 7618058579 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Kansas School of Med (KC/Wich/Sal), 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Colorado Radiologists, P.C.Group PAC ID 7517959794, 11 clinicians
Parkwest Imaging, L.L.CGroup PAC ID 3173415247, 11 clinicians

Practice addresses (Care Compare)

1619 N Greenwood St
Suite 103
Pueblo, CO 81003-2655
Phone (719) 542-2167

3676 Parker Blvd
Suite 165
Pueblo, CO 81008-2212
Phone (719) 595-7600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41232COMDDiagnostic Ultrasound Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Colorado Radiologists, P.C. CurrentSince May 1, 2003 Accepting new patients
Parkwest Imaging, L.L.C Diagnostic Radiology CurrentSince May 1, 2003 Accepting new patients
Radiology Associates Diagnostic Radiology PastSince May 1, 2003 Accepting new patients
Parkview Medical Center, Inc. Past Accepting new patients
Pueblo Imaging Center, LLC Past Accepting new patients

Locations

1619 N Greenwood St
Ste 103
Pueblo, CO 81003
Phone (719) 542-2167

3676 Parker Blvd
Ste 165
Pueblo, CO 81008
Phone (719) 253-7040

Organizations & group practices 5

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 7

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208390400000",
    "number": "1881640688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11512",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810010512",
            "telephone_number": "719-542-2167",
            "fax_number": "719-542-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 N GREENWOOD ST",
            "address_2": "SUITE 103",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032644",
            "telephone_number": "719-542-2167",
            "fax_number": "719-542-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOLT",
        "first_name": "BRYAN",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2008-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CO",
            "license": "41232",
            "primary": true
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "CO",
            "license": "41232",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61623334",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.