NPIMap

Organization Active NPI

Primary Care Partners, Inc.

  • Family Medicine Physician
  • Fruita, CO
National Provider Identifier
1972932622
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRIMARY CARE PARTNERS, INC.
Practice address
455 Kokopelli Blvd Ste C
Fruita, CO 81521-8710
Phone
(970) 256-5285
Fax
(970) 256-5290
NPI assigned
Nov 4, 2013
Organization subpart
Yes
Parent organization
PRIMARY CARE PARTNERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Authorized official

Name
Beverly J Clark
Title
Credentialing Coordinator
Phone
(970) 254-2642

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

455 Kokopelli Blvd Ste C
Fruita, CO 81521-8710

Mailing address

PO Box 10700
Grand Junction, CO 81502-5517
Phone (970) 254-2642

Other names 1

  • Red Canyon Family Medicine Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031209000400 CO Part B Supplier - Clinic/Group Practice 7810893161 Receives reassigned benefits from 84 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fruita, CO; Grand Junction, CO

Other NPIs on the same Medicare enrollment 8

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

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
06D2073692Red Canyon Family Medicine455 Kokopelli Blvd, Fruita, CO 81521Provider-performed microscopyFeb 23, 2028

National Provider Directory

National Provider Directory
Tax ID family
Grand Junction Diagnost8 organizations share this tax ID, including this one
Part of
Grand Junction Diagnost

Other organizations with this tax ID 7

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

Locations

455 Kokopelli Blvd
Ste C
Fruita, CO 81521
Phone (970) 256-5285

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1383523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1972932622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10700",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815025517",
            "telephone_number": "970-254-2642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 KOKOPELLI BLVD STE C",
            "city": "FRUITA",
            "state": "CO",
            "postal_code": "815218710",
            "telephone_number": "970-256-5285",
            "fax_number": "970-256-5290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE PARTNERS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CARE PARTNERS, INC.",
        "enumeration_date": "2013-11-04",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "970-254-2642"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red Canyon Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fruita, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.