Individual provider Active NPI

Brianna L Roselles

  • Clinical Social Worker
  • Fort Collins, CO
National Provider Identifier
1922751775
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW.09928141 Issued in CO
Practice address
3800 Automation Way Ste 102
Fort Collins, CO 80525-3451
Phone
(970) 900-5835
NPI assigned
Feb 1, 2022
Last updated
Jun 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X LSW.0009923926 CO
Clinical Social Worker 1041C0700X CSW.09928141 CO Primary

Addresses

Primary practice location

3800 Automation Way Ste 102
Fort Collins, CO 80525-3451

Mailing address

1650 S Topaz Way
Meridian, ID 83642-4474

Other practice location 1

4565 Kendall Pkwy
Loveland, CO 80538-9268
Phone (970) 410-8228

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250625004410 CO Practitioner - Clinical Social Worker 1153833991 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LSW.0009923926COMDSocial Worker
CSW.09928141COMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jun 1, 2025 Accepting new patients

Locations

1925 Mountain View Ave
Longmont, CO 80501
Phone (303) 776-1234

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1922751775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 S TOPAZ WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836424474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 AUTOMATION WAY STE 102",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253451",
            "telephone_number": "970-900-5835"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4565 Kendall Pkwy",
            "address_purpose": "LOCATION",
            "city": "Loveland",
            "state": "CO",
            "postal_code": "805389268",
            "country_code": "US",
            "telephone_number": "970-410-8228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSELLES",
        "first_name": "BRIANNA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-01",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CO",
            "license": "LSW.0009923926",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09928141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.