NPIMap

Organization Active NPI

Boulder Radiologists Inc P C

  • Diagnostic Radiology Physician
  • Boulder, CO
National Provider Identifier
1891756813
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
BOULDER RADIOLOGISTS INC P C
Practice address
4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone
(303) 473-7500
Fax
(303) 440-2168
NPI assigned
Mar 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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

Authorized official

Name
Roger Nichols II, M.D.NPI 1336114891
Title
President
Phone
(303) 473-7500

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X CO Primary

Addresses

Primary practice location

4747 Arapahoe Ave
Boulder, CO 80303-1131

Mailing address

42 Garden Ctr
Broomfield, CO 80020-1730
Phone (303) 465-0401

Other practice location 1

36 Garden Ctr
Broomfield, CO 80020-1730
Phone (303) 465-0401 ext. 102

Other identifiers 2

IdentifierTypeStateIssuer
04995049MedicaidCO
CS6650OtherCOMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040225000774 CO Part B Supplier - Clinic/Group Practice 4183510274 Receives reassigned benefits from 14 practitioners
Practice locations: Boulder, CO; Durango, CO; Broomfield, CO

National Provider Directory

National Provider Directory

Locations

4740 Pearl Pkwy
Ste 201
Boulder, CO 80301

2880 Folsom St
Ste 100
Boulder, CO 80304
Phone (303) 247-9696

1185 State Highway 7
Ste 120
Broomfield, CO 80023

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615766400000",
    "number": "1891756813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 GARDEN CTR",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800201730",
            "telephone_number": "303-465-0401",
            "fax_number": "303-438-1351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 ARAPAHOE AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031131",
            "telephone_number": "303-473-7500",
            "fax_number": "303-440-2168"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36 Garden Ctr",
            "address_purpose": "LOCATION",
            "city": "Broomfield",
            "state": "CO",
            "postal_code": "800201730",
            "country_code": "US",
            "telephone_number": "303-465-0401 x102",
            "fax_number": "303-438-1351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BOULDER RADIOLOGISTS INC P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-473-7500",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04995049",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CS6650",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; 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.