Mario J Imola, MD

Primary specialty

Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X

License

38335 Issued in CO

Practice address

3600 S Logan St
Suite 100
Englewood, CO 80113-3766

Phone

(303) 839-7980

Fax

(303) 839-7936

NPI assigned

Aug 15, 2005

Last updated

Oct 17, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Plastic and Reconstructive SurgeryAlso: Maxillofacial Surgery, Otolaryngology

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Colorado Facial Plastic Surgery Center IncGroup PAC ID 6305977745, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Colorado Facial Plastic Surgery Center Inc

  • Specialist
  • Englewood, CO
  • NPI 1114068376
  Medicare reassignment Care Compare group NPD Authorized official
• Trauma and Emergency Subspecialty Surgeons PLLC

  • Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
  • Highlands Ranch, CO
  • NPI 1740543933
  Medicare reassignment NPD

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1932101490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 S LOGAN ST",
            "address_2": "SUITE 100",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801133766",
            "telephone_number": "303-839-7980",
            "fax_number": "303-839-7936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 S LOGAN ST",
            "address_2": "SUITE 100",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801133766",
            "telephone_number": "303-839-7980",
            "fax_number": "303-839-7936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMOLA",
        "first_name": "MARIO",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "CO",
            "license": "38335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "841553144",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117142900",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95739831",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Icare Ambulance LLC
• Ignitus Denver LLC
• Cody Michael Ihling, DO
• Carolyn S Im
• Immersiv Health of Colorado, PLLC (Immersiv Health)
• Impact Physician Group, LLC
• Impact Physician Group, LLC
• Janet Marie Incitti, P.T.
• Charlotte Anne Indeck, RN, BSN
• Individual Dynamics

• Facial Plastic Surgery Physician in Englewood, CO
• Providers in Englewood, CO by specialty
• Facial Plastic Surgery Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.