NPIMap

Organization Active NPI

Boulder Valley Asthma & Allergy Clinics, PC

  • Specialist
  • Boulder, CO
National Provider Identifier
1952522997
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
BOULDER VALLEY ASTHMA & ALLERGY CLINICS, PC
Practice address
3950 Broadway St
Boulder, CO 80304-1104
Phone
(303) 234-1067
Fax
(303) 232-2967
NPI assigned
May 1, 2007
Last updated
Jun 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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

Authorized official

Name
Mark David Menich, MDNPI 1417983438
Title
Physician
Phone
(303) 234-1067

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
Specialist 174400000X CO Primary

Addresses

Primary practice location

3950 Broadway St
Boulder, CO 80304-1104

Mailing address

1746 Cole Blvd Ste 320
Lakewood, CO 80401-3208
Phone (303) 234-1067

Other identifiers 1

IdentifierTypeStateIssuer
04006102MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, KS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051013001064 CO Part B Supplier - Clinic/Group Practice 4284659632 Receives reassigned benefits from 11 practitioners
8 other NPIs on this enrollment
Practice locations: Arvada, CO; Westminster, CO; Littleton, CO; Lakewood, CO; Lafayette, CO; Englewood, CO; Denver, CO; Burlington, CO…
O20170410001444 KS Part B Supplier - Clinic/Group Practice 4284659632 Receives reassigned benefits from 2 practitioners
Practice locations: Goodland, KS

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Boulder Valley Asthma Allergy Clinics PC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

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": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591747200000",
    "number": "1952522997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1746 COLE BLVD STE 320",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "804013208",
            "telephone_number": "303-234-1067",
            "fax_number": "303-232-2967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803041104",
            "telephone_number": "303-234-1067",
            "fax_number": "303-232-2967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER VALLEY ASTHMA & ALLERGY CLINICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A",
        "authorized_official_last_name": "MENICH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "303-234-1067",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04006102",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.