NPIMap

Organization Active NPI

Coal Creek Family Medicine

  • Specialist
  • Louisville, CO
National Provider Identifier
1942407622
Registry record updated Sep 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
COAL CREEK FAMILY MEDICINE
Practice address
1044 S 88TH St
Ste 200
Louisville, CO 80027-9417
Phone
(303) 666-7119
Fax
(303) 666-5995
NPI assigned
Jun 27, 2007
Last updated
Sep 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2008

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

Authorized official

Name
Donielle Dutton
Title
Practice Manager
Phone
(303) 666-7119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

1044 S 88TH St
Ste 200
Louisville, CO 80027-9417

Mailing address

1044 S 88TH St
Ste 200
Louisville, CO 80027-9417
Phone (303) 666-7119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040129000996 CO Part B Supplier - Clinic/Group Practice 6709789480 Receives reassigned benefits from 10 practitioners
Practice locations: Louisville, CO

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

6870 W 52nd Ave
Ste 120
Arvada, CO 80002

1044 S 88th St
Ste 200
Louisville, CO 80027
Phone (303) 666-7119

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220486400000",
    "number": "1942407622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 S 88TH ST",
            "address_2": "STE 200",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800279417",
            "telephone_number": "303-666-7119",
            "fax_number": "303-666-5995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 S 88TH ST",
            "address_2": "STE 200",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800279417",
            "telephone_number": "303-666-7119",
            "fax_number": "303-666-5995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAL CREEK FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2008-09-04",
        "status": "A",
        "authorized_official_last_name": "DUTTON",
        "authorized_official_first_name": "DONIELLE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "303-666-7119"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.