NPIMap

Individual provider Active NPI

Robyn Nordstrom Lane, M.D.

  • Family Medicine Physician
  • Boulder, CO
National Provider Identifier
1902028079
Registry record updated Mar 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
52666 Issued in CO
Practice address
2750 Broadway St
Boulder, CO 80304-3573
Phone
(303) 440-3102
NPI assigned
May 2, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00046947 WA
Family Medicine Physician 207Q00000X 52666 CO Primary

Addresses

Primary practice location

2750 Broadway St
Boulder, CO 80304-3573

Mailing address

829 Mount Evans CT
Louisville, CO 80027-3112
Phone (720) 355-0440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131120000469 CO Practitioner - Family Practice 1850481565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Mayo Medical School, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boulder Medical Center, PCGroup PAC ID 4183536204, 86 clinicians

Practice addresses (Care Compare)

2750 Broadway St
Boulder, CO 80304-3573
Phone (303) 440-3000

4745 Arapahoe Ave
Suite 200
Boulder, CO 80303-1082
Phone (303) 938-4700

Hospital & facility affiliations

  • Boulder Community Health Hospital, Boulder, CO, CCN 060027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
52666COMDFamily Medicine Physician
MD00046947WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Medical Center, P.C. CurrentSince Aug 27, 2013 Accepting new patients
Boulder Medical Center, P.C. CurrentSince Aug 27, 2013 Accepting new patients
Boulder Medical Center, P.C. Current Accepting new patients
Boulder Medical Center, P.C. Past Accepting new patients
Caresimple Providers PS Family Medicine Past Accepting new patients
Medical Center Pharmacy Inc Past Accepting new patients
Carena Medical Providers PS Family Medicine Past Accepting new patients

Locations

4745 Arapahoe Ave
Ste 200
Boulder, CO 80303
Phone (303) 938-4710

2750 Broadway St
Boulder, CO 80304
Phone (303) 440-3000

Organizations & group practices 7

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.

Hospital & facility affiliations 34

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489017600000",
    "number": "1902028079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 MOUNT EVANS CT",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800273112",
            "telephone_number": "720-355-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043573",
            "telephone_number": "303-440-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDSTROM LANE",
        "first_name": "ROBYN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2017-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00046947",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "52666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.