NPIMap

Organization Active NPI

Portercare Adventist Health System

Doing business as AdventHealth Medical Group Breast Surgery at Lone Tree

  • Surgery Physician
  • Lone Tree, CO
National Provider Identifier
1891503322
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
PORTERCARE ADVENTIST HEALTH SYSTEM
Doing business as
AdventHealth Medical Group Breast Surgery at Lone Tree
Practice address
9695 S Yosemite St Ste 385
Lone Tree, CO 80124-2890
Phone
(303) 715-7119
Fax
(303) 879-6180
NPI assigned
Dec 30, 2024
Last updated
Dec 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Authorized official

Name
Jason Tacha
Title
Coo
Phone
(303) 304-7752

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

9695 S Yosemite St Ste 385
Lone Tree, CO 80124-2890

Mailing address

PO Box 713425
Chicago, IL 60677-4325

Other names 1

  • AdventHealth Medical Group Breast Surgery at Lone Tree Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090115000327 CO Part B Supplier - Clinic/Group Practice 0941110886 Receives reassigned benefits from 869 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Porter Clinical Laborat216 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1735516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1891503322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713425",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606774325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9695 S YOSEMITE ST STE 385",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801242890",
            "telephone_number": "303-715-7119",
            "fax_number": "303-879-6180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTERCARE ADVENTIST HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-30",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "TACHA",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "303-304-7752"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AdventHealth Medical Group Breast Surgery at Lone Tree",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lone Tree, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; 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.