NPIMap

Organization Active NPI

Prairie Medical Clinic PLLC

  • Family Medicine Physician
  • Pueblo, CO
National Provider Identifier
1891914693
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRAIRIE MEDICAL CLINIC PLLC
Practice address
1726 S Prairie Ave
Pueblo, CO 81005-2253
Phone
(719) 561-8660
Fax
(719) 561-8660
NPI assigned
Apr 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Benjamin Martinez, MDNPI 1932328663
Title
Physician
Phone
(719) 561-1291

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X CO Primary

Addresses

Primary practice location

1726 S Prairie Ave
Pueblo, CO 81005-2253

Mailing address

1726 S Prairie Ave
Pueblo, CO 81005-2253
Phone (719) 561-8660

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891914693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 S PRAIRIE AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052253",
            "telephone_number": "719-561-8660",
            "fax_number": "719-561-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1726 S PRAIRIE AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052253",
            "telephone_number": "719-561-8660",
            "fax_number": "719-561-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "719-561-1291",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.