NPIMap

Individual provider Active NPI

Gustavo A Colmenares, MD

  • Emergency Medicine Physician
  • Mint Hill, NC
National Provider Identifier
1972587467
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DR.0056015 Issued in CO
Practice address
10545 Blair Rd
Suite 1200
Mint Hill, NC 28227-2800
Phone
(704) 863-9600
Fax
(704) 863-9601
NPI assigned
Nov 30, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DR.0056015 CO
Family Medicine Physician 207Q00000X 31295 SC
Family Medicine Physician 207Q00000X 2008-01450 NC
Emergency Medicine Physician 207P00000X DR.0056015 CO Primary

Addresses

Primary practice location

10545 Blair Rd
Suite 1200
Mint Hill, NC 28227-2800

Mailing address

PO Box 602478
Charlotte, NC 28260-2478
Phone (704) 863-9600

Other identifiers 2

IdentifierTypeStateIssuer
5910201MedicaidNC
312959MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170803000767 CO Practitioner - Emergency MedicinePractitioner - Family Practice 8022191741 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Colorado Complete Urgent Care Physicians LLC 7 clinicians

Practice addresses (Care Compare)

8115 Voyager Pkwy
Colorado Springs, CO 80920-1562
Phone (719) 203-3300

Hospital & facility affiliations

  • Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR.0056015COMDFamily Medicine Physician
2008-01450NCMDFamily Medicine Physician
1450NCMDPediatric Occupational Therapist
31295SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prowers County Hospital District CurrentSince Nov 28, 2023 Accepting new patients
Union Urgent Care LLC Family Medicine Past Accepting new patients
United Hospital District Inc. PastSince Oct 31, 2021 Accepting new patients
Carolinas Physicians Network Inc Family Medicine Past Accepting new patients
Carolinas Physicians Network Inc Family Medicine Past Accepting new patients
Carolinas Physicians Network Inc Family Medicine Past Accepting new patients
Laurel Mill Emergency Physicians Emergency Medicine Past Accepting new patients
Cabarrus Urgent Care Family Medicine Past Accepting new patients
Complete Emergency Care Colorado Springs LLC Past Accepting new patients
Union Urgent Care LLC Family Medicine Past Accepting new patients
United Hospital District Inc. Family Medicine Past Accepting new patients

Locations

401 Kendall Dr
Lamar, CO 81052
Phone (719) 336-4343

Organizations & group practices 12

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

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1972587467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602478",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602478",
            "telephone_number": "704-863-9600",
            "fax_number": "704-863-9601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10545 BLAIR RD",
            "address_2": "SUITE 1200",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282272800",
            "telephone_number": "704-863-9600",
            "fax_number": "704-863-9601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLMENARES",
        "first_name": "GUSTAVO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0056015",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "31295",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2008-01450",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "DR.0056015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5910201",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "312959",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mint Hill, NC

Sources for this page

Verify at the official NPI Registry.