Individual provider Active NPI

Thomas Julian Krasny Ergen, M.D.

  • Orthopaedic Surgery Physician
  • Aurora, CO
National Provider Identifier
1891175501
Registry record updated Jan 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
DR0064422 Issued in CO
Practice address
12631 E 17TH Ave Ofc 1
Aurora, CO 80045-2527
Phone
(303) 724-7378
Fax
(803) 434-4183
NPI assigned
Jun 8, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X DR0064422 CO Primary

Addresses

Primary practice location

12631 E 17TH Ave Ofc 1
Aurora, CO 80045-2527

Mailing address

12631 E 17TH Ave Ofc 1B202
Aurora, CO 80045-2527
Phone (865) 385-7424

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE) Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240412003938 GA Practitioner - Orthopedic Surgery 0042637274 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Medical College of Georgia School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

3495 Piedmont Rd NE
Atlanta, GA 30305-1729
Phone (404) 364-7206

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR0064422COMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Southeast Permanente Medical Group CurrentSince Feb 20, 2024 Accepting new patients

Locations

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

3650 Steve Reynolds Blvd
Duluth, GA 30096
Phone (770) 931-6010

750 Townpark Ln NW
Kennesaw, GA 30144
Phone (770) 514-5401

20 Glenlake Pkwy
Sandy Springs, GA 30328
Phone (770) 677-6247

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1891175501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12631 E 17TH AVE OFC 1B202",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800452527",
            "telephone_number": "865-385-7424",
            "fax_number": "803-434-4183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12631 E 17TH AVE OFC 1",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800452527",
            "telephone_number": "303-724-7378",
            "fax_number": "803-434-4183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERGEN",
        "first_name": "THOMAS",
        "middle_name": "JULIAN KRASNY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-08",
        "last_updated": "2022-01-18",
        "certification_date": "2020-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CO",
            "license": "DR0064422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "750 Townpark Ln NW",
            "city": "Kennesaw",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301445579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.