Active NPI
Intermountain Medical Group Denver, LLC
- Family Medicine Physician
- Burley, ID
National Provider Identifier
1922979236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
- Practice address
- 1501 Hiland Ave Ste F
Burley, ID 83318-2682 - Phone
- (801) 442-5502
- NPI assigned
- Sep 17, 2025
- Organization subpart
- Yes
- Parent organization
- INTERMOUNTAIN FRONT RANGE, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jon McDaniel
- Title
- VP Finance
- Phone
- (303) 272-0231
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
1501 Hiland Ave Ste F
Burley, ID 83318-2682
Mailing address
500 Eldorado Blvd Ste 4300
Broomfield, CO 80021-3564
Phone (303) 272-0566
National Provider Directory
National Provider Directory- Tax ID family
- Intermountain Medical Group Denver LLC
- Part of
- Lutheran Medical Center
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758067200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1758067200000",
"number": "1922979236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 ELDORADO BLVD STE 4300",
"city": "BROOMFIELD",
"state": "CO",
"postal_code": "800213564",
"telephone_number": "303-272-0566",
"fax_number": "303-272-0390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 HILAND AVE STE F",
"city": "BURLEY",
"state": "ID",
"postal_code": "833182682",
"telephone_number": "801-442-5502"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INTERMOUNTAIN MEDICAL GROUP DENVER, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
"enumeration_date": "2025-09-17",
"last_updated": "2025-09-17",
"certification_date": "2025-09-17",
"status": "A",
"authorized_official_last_name": "MCDANIEL",
"authorized_official_first_name": "JON",
"authorized_official_title_or_position": "VP FINANCE",
"authorized_official_telephone_number": "303-272-0231"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.