NPIMap

Individual provider Active NPI

Jie Mao, M.D.

  • Diagnostic Radiology Physician
  • Boulder, CO
National Provider Identifier
1942293485
Registry record updated Mar 15, 2021
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Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
41795 Issued in CO
Practice address
1100 Balsam Ave
Radiology
Boulder, CO 80304-3404
Phone
(303) 440-2273
NPI assigned
Aug 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 41795 CO Primary
Vascular & Interventional Radiology Physician 2085R0204X DR.0041795 CO

Addresses

Primary practice location

1100 Balsam Ave
Radiology
Boulder, CO 80304-3404

Mailing address

42 Garden Ctr
Broomfield, CO 80020-1730
Phone (303) 465-0401

Other practice location 1

4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 465-0401

Other identifiers 1

IdentifierTypeStateIssuer
96073721MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040305000306 CO Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 6800784539 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
University of Florida College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Radiologists Inc P CGroup PAC ID 4183510274, 13 clinicians

Practice addresses (Care Compare)

4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 465-0401

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal25
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
41795COMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Radiologists Inc P C Diagnostic Radiology CurrentSince Aug 1, 2003 Accepting new patients
Bouldercentre for Orthopedics PC Past Accepting new patients

Locations

4747 Arapahoe Ave
Boulder, CO 80303
Phone (303) 415-7000

2880 Folsom St
Ste 100
Boulder, CO 80304
Phone (303) 247-9696

1100 Balsam Ave
Boulder, CO 80304
Phone (303) 415-7000

2750 Broadway St
Boulder, CO 80304
Phone (303) 440-3000

4740 Pearl Pkwy
Ste 110
Boulder, CO 80301

6685 Gunpark Dr
Ste 102
Boulder, CO 80301
Phone (303) 415-5199

36 Garden Ctr
Broomfield, CO 80020
Phone (303) 465-0401

42 Garden Ctr
Broomfield, CO 80020

101 Erie Pkwy
Erie, CO 80516
Phone (303) 415-5170

1000 W South Boulder Rd
Ste 105
Lafayette, CO 80026
Phone (303) 604-5031

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 and National Provider Directory roles.

Hospital & facility affiliations 61

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1942293485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 GARDEN CTR",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800201730",
            "telephone_number": "303-465-0401",
            "fax_number": "303-438-1351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 BALSAM AVE",
            "address_2": "RADIOLOGY",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043404",
            "telephone_number": "303-440-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4747 Arapahoe Ave",
            "address_purpose": "LOCATION",
            "city": "Boulder",
            "state": "CO",
            "postal_code": "803031131",
            "country_code": "US",
            "telephone_number": "303-465-0401",
            "fax_number": "303-438-1351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAO",
        "first_name": "JIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-30",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CO",
            "license": "41795",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CO",
            "license": "DR.0041795",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "96073721",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.