NPIMap

Organization Active NPI

CS Cardiology Newco LLC

  • Cardiovascular Disease Physician
  • Canon City, CO
National Provider Identifier
1962283887
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CS CARDIOLOGY NEWCO LLC
Practice address
1338 Phay Ave
Canon City, CO 81212-2311
Phone
(719) 960-0363
NPI assigned
Oct 6, 2023
Last updated
Apr 4, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CS CARDIOLOGY NEWCO LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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

Authorized official

Name
Erin Petrie
Title
VP of RCM
Phone
(708) 498-4493

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X

Addresses

Primary practice location

1338 Phay Ave
Canon City, CO 81212-2311

Mailing address

1338 Phay Ave
Canon City, CO 81212-2311

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230901000086 CO Part B Supplier - Clinic/Group Practice 2365805736 Receives reassigned benefits from 57 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Canon City, CO; Colorado Springs, CO; Durango, CO; Pueblo West, CO

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
CS Cardiology Newco LLC9 organizations share this tax ID, including this one
Part of
CS Cardiology Newco LLC

Other organizations with this tax ID 8

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

Locations

904 E Hailey Ln
Ste C
Pueblo West, CO 81007

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1696550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1962283887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1338 PHAY AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1338 PHAY AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122311",
            "telephone_number": "719-960-0363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CS CARDIOLOGY NEWCO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CS CARDIOLOGY NEWCO LLC",
        "enumeration_date": "2023-10-06",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "PETRIE",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "VP OF RCM",
        "authorized_official_telephone_number": "708-498-4493"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.