NPIMap

Organization Active NPI

Colorado Primary Care Clinic Inc

  • Nurse Practitioner
  • Aurora, CO
National Provider Identifier
1942525902
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
363L00000X Issued in CO
Legal business name
COLORADO PRIMARY CARE CLINIC INC
Practice address
14991 E Hampden Ave Ste 110
Aurora, CO 80014-3980
Phone
(303) 343-9500
Fax
(303) 343-9506
NPI assigned
Apr 2, 2010
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Dawn Ann Fetzko, NURSE PRACTITIONERNPI 1346464070
Title
Nurse Practitioner
Phone
(303) 343-9500

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
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X 363L00000X CO Primary

Addresses

Primary practice location

14991 E Hampden Ave Ste 110
Aurora, CO 80014-3980

Mailing address

14991 E Hampden Ave Ste 110
Aurora, CO 80014-3980
Phone (303) 343-9500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100713000644 CO Part B Supplier - Clinic/Group Practice 3173655032 Receives reassigned benefits from 22 practitioners
Practice locations: Aurora, CO

National Provider Directory

National Provider Directory

Locations

11275 E Mississippi Ave
Ste 2S6
Aurora, CO 80012
Phone (303) 343-3910

14991 E Hampden Ave
Aurora, CO 80014
Phone (303) 699-1964

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1270166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1942525902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14991 E HAMPDEN AVE STE 110",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800143980",
            "telephone_number": "303-343-9500",
            "fax_number": "303-343-9506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14991 E HAMPDEN AVE STE 110",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800143980",
            "telephone_number": "303-343-9500",
            "fax_number": "303-343-9506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO PRIMARY CARE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-02",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "FETZKO",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "303-343-9500",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "363L00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.