NPIMap

Organization Active NPI

Rocky Mountain Clinics LLC

  • Addiction Medicine (Family Medicine) Physician
  • Boulder, CO
National Provider Identifier
1922724707
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
ROCKY MOUNTAIN CLINICS LLC
Practice address
4730 Table Mesa Dr Ste A100
Boulder, CO 80305-5574
Phone
(720) 476-7957
NPI assigned
Oct 13, 2022
Last updated
Mar 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Authorized official

Name
Sabrina Gibson
Title
Cfo
Phone
(970) 493-9193

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Addiction Medicine (Family Medicine) Physician 207QA0401X Primary

Addresses

Primary practice location

4730 Table Mesa Dr Ste A100
Boulder, CO 80305-5574

Mailing address

1120 E Elizabeth St Ste G2
Fort Collins, CO 80524-4044

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230117001707 CO Part B Supplier - Clinic/Group Practice 5597136218 Receives reassigned benefits from 79 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gunnison, CO; La Junta, CO; Lakewood, CO; Las Animas, CO; Longmont, CO; Loveland, CO; Northglenn, CO; Pueblo, CO…

Other NPIs on the same Medicare enrollment 30

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

View all 30

National Provider Directory

National Provider Directory
Tax ID family
Rocky Mountain Clinics LLC43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

Locations

4730 Table Mesa Dr
Ste A100
Boulder, CO 80305
Phone (303) 444-3823

Practitioners & affiliated clinicians

Practitioners 54

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 54

NPI Registry JSON

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

{
    "created_epoch": "1665619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1922724707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E ELIZABETH ST STE G2",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 TABLE MESA DR STE A100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803055574",
            "telephone_number": "720-476-7957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKY MOUNTAIN CLINICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-13",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "SABRINA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "970-493-9193"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 5, 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.