NPIMap

Organization Active NPI

Intermountain Medical Group Denver, LLC

Doing business as Denver Midtown Clinic - Surgery

  • 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
Doing business as
Denver Midtown Clinic - Surgery
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
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Authorized official

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

Specialties & licenses 1

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

Addresses

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

  • Denver Midtown Clinic - Surgery Doing business as

Medicare participation

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

Enrollment records 1

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

National Provider Directory
Tax ID family
SCL Health Medical Group122 organizations share this tax ID, including this one
Part of
Exempla S Bdwy Med CNTR

Organizations with this tax ID in the same state 19

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

View all 19

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "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.