NPIMap

Organization Active NPI

Optumcare Colorado Medical Group LLC

Doing business as Optum Colorado Springs at Colorado College

  • Non-Pharmacy Dispensing Site
  • Colorado Springs, CO
National Provider Identifier
1952652422
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
OPTUMCARE COLORADO MEDICAL GROUP LLC
Doing business as
Optum Colorado Springs at Colorado College
Practice address
1106 N Cascade Ave
Colorado Springs, CO 80903-1355
Phone
(719) 389-6384
NPI assigned
Sep 25, 2012
Last updated
Aug 20, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
OPTUMCARE COLORADO MEDICAL GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Authorized official

Name
Emily Castillo
Title
Associate Director Credentialing
Phone
(702) 579-3253

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

1106 N Cascade Ave
Colorado Springs, CO 80903-1355

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Other identifiers 1

IdentifierTypeStateIssuer
04740080MedicaidCO

Other names 4

  • Optum Colorado Springs at Colorado College Doing business as
  • Colorado Springs Health Partners LLC Former legal business name
  • DaVita Medical Group Colorado Springs LLC Former legal business name
  • OptumCare Colorado Springs LLC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Optumcare Colorado Medical Group LLC61 organizations share this tax ID, including this one
Part of
Optumcare Colorado Medical Group LLC

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Locations

1106 N Cascade Ave
Colorado Springs, CO 80903
Phone (719) 389-6384

NPI Registry JSON

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

{
    "created_epoch": "1348531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1952652422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 N CASCADE AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809031355",
            "telephone_number": "719-389-6384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE COLORADO MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTUMCARE COLORADO MEDICAL GROUP LLC",
        "enumeration_date": "2012-09-25",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR CREDENTIALING",
        "authorized_official_telephone_number": "702-579-3253"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04740080",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optum Colorado Springs at Colorado College",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colorado Springs Health Partners LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "DaVita Medical Group Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "OptumCare Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.