NPIMap

Organization Active NPI

Intermountain Medical Group Denver, LLC

  • Plastic Surgery Physician
  • Denver, CO
National Provider Identifier
1962016352
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
Practice address
1960 N Ogden St Ste 530
Denver, CO 80218-3671
Phone
(303) 318-2600
Fax
(303) 318-2604
NPI assigned
Sep 2, 2020
Organization subpart
Yes
Parent organization
INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

Authorized official

NPPES NPI Registry
Name
Jon McDaniel
Title
VP Finance Medical Group
Phone
(303) 272-0231

Corporate family (same tax ID) 19

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

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20150106000131 CO Part B Supplier - Clinic/Group Practice 0840513552 Receives reassigned benefits from 1,361 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Intermountain Medical Group Denver LLC (121 organizations share this tax ID)
Part of
Lutheran Medical Center

Locations

1960 N Ogden St
Ste 530
Denver, CO 80218
Phone (303) 318-2600

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X Primary

Addresses

NPPES NPI Registry

Primary practice location

1960 N Ogden St Ste 530
Denver, CO 80218-3671

Mailing address

1960 N Ogden St Ste 530
Denver, CO 80218-3671
Phone (303) 318-2600

Other names 1

NPPES NPI Registry
  • Denver Midtown Clinic - Surgery Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 28, 2024.

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1962016352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 N OGDEN ST STE 530",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802183671",
            "telephone_number": "303-318-2600",
            "fax_number": "303-318-2604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 N OGDEN ST STE 530",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802183671",
            "telephone_number": "303-318-2600",
            "fax_number": "303-318-2604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP DENVER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "enumeration_date": "2020-09-02",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP FINANCE MEDICAL GROUP",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Denver Midtown Clinic - Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; 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.