NPIMap

Organization Active NPI

Cherry Creek Pediatrics, PC

  • Pediatrics Physician
  • Denver, CO
National Provider Identifier
1942265624
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
24963 Issued in CO
Legal business name
CHERRY CREEK PEDIATRICS, PC
Practice address
4900 E Kentucky Ave
Denver, CO 80246-2365
Phone
(303) 756-0101
Fax
(303) 756-1408
NPI assigned
Apr 18, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jody L Mathie, M.D.NPI 1508991936
Title
Owner/Physician
Phone
(303) 756-0101

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 24963 CO Primary

Addresses

Primary practice location

4900 E Kentucky Ave
Denver, CO 80246-2365

Mailing address

4900 E Kentucky Ave
Denver, CO 80246-2365
Phone (303) 756-0101

Other identifiers 1

IdentifierTypeStateIssuer
54388074MedicaidCO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2034757Cherry Creek Pediatrics4900 E Kentucky Ave, Denver, CO 80246Certificate of waiverJan 3, 2028

National Provider Directory

National Provider Directory

Locations

4900 E Kentucky Ave
Denver, CO 80246
Phone (303) 756-0101

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942265624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 E KENTUCKY AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802462365",
            "telephone_number": "303-756-0101",
            "fax_number": "303-756-1408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 E KENTUCKY AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802462365",
            "telephone_number": "303-756-0101",
            "fax_number": "303-756-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERRY CREEK PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MATHIE",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "303-756-0101",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "24963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54388074",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.