Individual provider Active NPI

Alice Melinda Poland, RXN, NP

  • Women's Health Nurse Practitioner
  • Colorado Springs, CO
National Provider Identifier
1962476234
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
88791 Issued in CO
Practice address
5333 N Union Blvd Ste 300
Colorado Springs, CO 80918-2051
Phone
(970) 493-7442
Fax
(970) 493-2990
NPI assigned
Feb 14, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 88791 CO Primary

Addresses

Primary practice location

5333 N Union Blvd Ste 300
Colorado Springs, CO 80918-2051

Mailing address

5333 N Union Blvd Ste 200
Colorado Springs, CO 80918-2051
Phone (719) 598-0500

Other identifiers 1

IdentifierTypeStateIssuer
7887912MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201201000355 CO Practitioner - Nurse Practitioner 1254742075 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
88791COMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Optumcare Colorado Medical Group LLC CurrentSince May 10, 2024 Accepting new patients
Poudre Valley Medical Group, LLC Past Accepting new patients
Mountain View OBGYN Past Accepting new patients

Locations

2405 Research Pkwy
Colorado Springs, CO 80920
Phone (719) 268-2800

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1962476234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5333 N UNION BLVD STE 200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809182051",
            "telephone_number": "719-598-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5333 N UNION BLVD STE 300",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809182051",
            "telephone_number": "970-493-7442",
            "fax_number": "970-493-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLAND",
        "first_name": "ALICE",
        "middle_name": "MELINDA",
        "credential": "RXN, NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-14",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CO",
            "license": "88791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7887912",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.