NPIMap

Organization Active NPI

Children'S Clinic of Pueblo, PC

  • Pediatrics Physician
  • Pueblo, CO
National Provider Identifier
1962553172
Registry record updated Dec 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
36942 Issued in CO
Legal business name
CHILDREN'S CLINIC OF PUEBLO, PC
Practice address
1600 N Grand Ave
Suite 240
Pueblo, CO 81003-2700
Phone
(719) 295-2305
Fax
(719) 295-2320
NPI assigned
Jan 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2011

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

Authorized official

Name
Loraine L. Carroll, M.D.NPI 1801828850
Title
Physician
Phone
(719) 295-2305

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X 36942 CO Primary

Addresses

Primary practice location

1600 N Grand Ave
Suite 240
Pueblo, CO 81003-2700

Mailing address

1600 N Grand Ave
Suite 240
Pueblo, CO 81003-2700
Phone (719) 295-2305

Other identifiers 2

IdentifierTypeStateIssuer
49708864MedicaidCO
CH636086OtherBCBS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0967615Children'S Clinic of Pueblo PC1600 N Grand Ave, Pueblo, CO 81003Certificate of waiverNov 16, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323388800000",
    "number": "1962553172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 N GRAND AVE",
            "address_2": "SUITE 240",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032700",
            "telephone_number": "719-295-2305",
            "fax_number": "719-295-2320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 N GRAND AVE",
            "address_2": "SUITE 240",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032700",
            "telephone_number": "719-295-2305",
            "fax_number": "719-295-2320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S CLINIC OF PUEBLO, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2011-12-09",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "LORAINE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "719-295-2305",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "36942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49708864",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "CH636086",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.