NPIMap

Organization Active NPI

Colorado Mountain Medical, LLC

  • Community/Behavioral Health Agency
  • Frisco, CO
National Provider Identifier
1982270138
Registry record updated May 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COLORADO MOUNTAIN MEDICAL, LLC
Practice address
323 W Main St Ste 101
Frisco, CO 80443-5966
Phone
(970) 926-6340
NPI assigned
May 28, 2021
Last updated
May 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2021

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

Authorized official

Name
Lisa Kerstiens
Title
Physician Relations Manager
Phone
(970) 845-2903

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

323 W Main St Ste 101
Frisco, CO 80443-5966

Mailing address

PO Box 4330
Avon, CO 81620-4330
Phone (970) 926-6340

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191030000595 CO Part B Supplier - Clinic/Group Practice 5496087181 Receives reassigned benefits from 70 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vail, CO; Glenwood Spring, CO; Frisco, CO; Edwards, CO; Eagle, CO; Avon, CO; Dillon, CO

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory
Tax ID family
Colorado Mountain Medical LLC28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1622160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622160000000",
    "number": "1982270138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4330",
            "city": "AVON",
            "state": "CO",
            "postal_code": "816204330",
            "telephone_number": "970-926-6340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 W MAIN ST STE 101",
            "city": "FRISCO",
            "state": "CO",
            "postal_code": "804435966",
            "telephone_number": "970-926-6340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO MOUNTAIN MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-28",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A",
        "authorized_official_last_name": "KERSTIENS",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PHYSICIAN RELATIONS MANAGER",
        "authorized_official_telephone_number": "970-845-2903"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frisco, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.