NPIMap

Organization Active NPI

Optumcare Colorado Medical Group LLC

Doing business as Mdvip Dr Theodore Lawson

  • Family Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1902437874
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OPTUMCARE COLORADO MEDICAL GROUP LLC
Doing business as
Mdvip Dr Theodore Lawson
Practice address
3470 Centennial Blvd Ste 210
Colorado Springs, CO 80907-8669
Phone
(719) 463-5600
Fax
(719) 538-2990
NPI assigned
Jan 30, 2020
Last updated
Aug 20, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
OPTUMCARE COLORADO MEDICAL GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Authorized official

Name
Emily Castillo
Title
Associate Director Credentialing
Phone
(702) 579-3253

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

3470 Centennial Blvd Ste 210
Colorado Springs, CO 80907-8669

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Other names 2

  • MDVIP DR THEODORE LAWSON Doing business as
  • Optumcare Colorado Springs LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150129000413 CO Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 386 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Littleton, CO; Evergreen, CO; Golden, CO; Highlands Ranch, CO; Lakewood, CO; Aurora, CO; Lone Tree, CO; Longmont, CO…

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Davita Med GRP Co Springs61 organizations share this tax ID, including this one
Part of
Davita Med GRP Co Springs

Organizations with this tax ID in the same state 18

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

View all 18

Locations

2610 Tenderfoot Hill St
Colorado Springs, CO 80906
Phone (719) 576-3901

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1902437874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203",
            "fax_number": "719-538-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3470 CENTENNIAL BLVD STE 210",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809078669",
            "telephone_number": "719-463-5600",
            "fax_number": "719-538-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE COLORADO MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTUMCARE COLORADO MEDICAL GROUP LLC",
        "enumeration_date": "2020-01-30",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR CREDENTIALING",
        "authorized_official_telephone_number": "702-579-3253"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MDVIP DR THEODORE LAWSON",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optumcare Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.