NPIMap

Organization Active NPI

VVMC Diversified Services

Doing business as Vail Valley OB Gyn Associates

  • Specialist
  • Edwards, CO
National Provider Identifier
1881809457
Registry record updated Apr 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
VVMC DIVERSIFIED SERVICES
Doing business as
Vail Valley OB Gyn Associates
Practice address
322 Beard Creek Road
Edwards, CO 81632
Phone
(970) 569-3850
Fax
(970) 569-7756
NPI assigned
May 14, 2007
Last updated
Apr 29, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
VAIL CLINIC INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 29, 2009

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

Authorized official

Name
Mr. Charles W Crevling
Title
Cfo
Phone
(970) 479-7238

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

322 Beard Creek Road
Edwards, CO 81632

Mailing address

PO Box 848997
Boston, MA 02284-8997
Phone (970) 777-2834

Other identifiers 1

IdentifierTypeStateIssuer
48758531MedicaidCO

Other names 1

  • Vail Valley OB Gyn Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080919000433 CO Part B Supplier - Clinic/Group Practice 8628145414 Receives reassigned benefits from 26 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vail, CO; Loveland, CO; Leadville, CO; Greeley, CO; Edwards, CO; Fort Collins, CO; Aurora, CO; Eagle, CO…

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

National Provider Directory

National Provider Directory
Part of
Eagle Care Medical Clinic

Locations

322 Beard Creek Rd
Edwards, CO 81632
Phone (970) 569-7429

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240963200000",
    "number": "1881809457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 848997",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022848997",
            "telephone_number": "970-777-2834",
            "fax_number": "970-777-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 BEARD CREEK ROAD",
            "city": "EDWARDS",
            "state": "CO",
            "postal_code": "81632",
            "telephone_number": "970-569-3850",
            "fax_number": "970-569-7756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VVMC DIVERSIFIED SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VAIL CLINIC INC",
        "enumeration_date": "2007-05-14",
        "last_updated": "2009-04-29",
        "status": "A",
        "authorized_official_last_name": "CREVLING",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "970-479-7238",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48758531",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vail Valley OB Gyn Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edwards, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.