NPIMap

Organization Active NPI

Internal Medicine Clinic Inc.

  • Specialist
  • Fort Collins, CO
National Provider Identifier
1881725844
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
12-06712 Issued in CO
Legal business name
INTERNAL MEDICINE CLINIC INC.
Practice address
2021 Battlecreek Dr Unit B
Fort Collins, CO 80528-5120
Phone
(970) 224-9508
Fax
(970) 993-4289
NPI assigned
Mar 8, 2007
Last updated
Dec 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Authorized official

Name
Mrs. Alicia D Goossens
Title
Practice Admin
Phone
(970) 224-9508

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 12-06712 CO Primary

Addresses

Primary practice location

2021 Battlecreek Dr Unit B
Fort Collins, CO 80528-5120

Mailing address

2021 Battlecreek Dr Unit B
Fort Collins, CO 80528-5120
Phone (970) 224-9508

Other identifiers 1

IdentifierTypeStateIssuer
04014205MedicaidCO

National Provider Directory

National Provider Directory

Locations

2021 Battlecreek Dr
Unit B
Fort Collins, CO 80528
Phone (970) 224-9508

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607040000000",
    "number": "1881725844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 BATTLECREEK DR UNIT B",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805285120",
            "telephone_number": "970-224-9508",
            "fax_number": "970-999-3428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 BATTLECREEK DR UNIT B",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805285120",
            "telephone_number": "970-224-9508",
            "fax_number": "970-993-4289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A",
        "authorized_official_last_name": "GOOSSENS",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRACTICE ADMIN",
        "authorized_official_telephone_number": "970-224-9508",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CO",
            "license": "12-06712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04014205",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.