NPIMap

Organization Active NPI

Todd Dextradeur MD PC

  • Internal Medicine Physician
  • Thornton, CO
National Provider Identifier
1881864072
Registry record updated Oct 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
TODD DEXTRADEUR MD PC
Practice address
51 W. 84TH Ave
Ste 300
Thornton, CO 80260-4883
Phone
(720) 289-8184
Fax
(303) 457-2341
NPI assigned
Mar 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2020

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

Authorized official

Name
Todd C. Dextradeur, MDNPI 1801845532
Title
Owner/Physician
Phone
(720) 289-8184

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary
Sleep Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RS0012X 35500 CO

Addresses

Primary practice location

51 W. 84TH Ave
Ste 300
Thornton, CO 80260-4883

Mailing address

1324 S. Race Street
Denver, CO 80210-2332
Phone (720) 289-8184

Other identifiers 2

IdentifierTypeStateIssuer
35500OtherCOMEDICAL LIC
01355007MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040304001151 CO Part B Supplier - Clinic/Group Practice 9335037183 Receives reassigned benefits from 1 practitioner
Practice locations: Thornton, CO

National Provider Directory

National Provider Directory

Locations

51 W 84th Ave
Ste 300
Thornton, CO 80260
Phone (303) 252-7790

9351 Grant St
Ste 400
Thornton, CO 80229
Phone (303) 452-0059

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1881864072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1324 S. RACE STREET",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802102332",
            "telephone_number": "720-289-8184",
            "fax_number": "303-457-2341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 W. 84TH AVE",
            "address_2": "STE 300",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802604883",
            "telephone_number": "720-289-8184",
            "fax_number": "303-457-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TODD DEXTRADEUR MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-04",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A",
        "authorized_official_last_name": "DEXTRADEUR",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "720-289-8184",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "CO",
            "license": "35500",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LIC",
            "identifier": "35500",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01355007",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thornton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; 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.