NPIMap

Individual provider Active NPI

Callie Davidson, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Pueblo, CO
National Provider Identifier
1982289625
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN.0996306-NP Issued in CO
Practice address
1120 Minnequa Ave
Pueblo, CO 81004-3734
Phone
(719) 281-3285
NPI assigned
Mar 15, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN.0996306-NP CO Primary

Addresses

Primary practice location

1120 Minnequa Ave
Pueblo, CO 81004-3734

Mailing address

75 Printers Pkwy
Ste 200
Colorado Springs, CO 80910-3142

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
I20211018001177 CO Practitioner - Nurse Practitioner 0042618381 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Primary CareGroup PAC ID 3577988864, 9 clinicians

Practice addresses (Care Compare)

1120 Minnequa Ave
Pueblo, CO 81004-3734
Phone (719) 281-3285

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Primary Care CurrentSince Oct 1, 2021 Accepting new patients
Summit Primary Care CurrentSince May 1, 2020 Accepting new patients
Summit Primary Care CurrentSince Oct 1, 2021 Accepting new patients

Locations

75 Printers Pkwy
Ste 200
Colorado Springs, CO 80910
Phone (719) 300-1122

300 E Hampden Ave
Ste 201
Englewood, CO 80113
Phone (303) 991-7700

1120 Minnequa Ave
Pueblo, CO 81004
Phone (719) 281-3285

Interoperability endpoints

  • Direct secure messaging: summitprimarycare.calliedavidson@157142.advancedmd-direct.com

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 and National Provider Directory roles.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1615766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646784000000",
    "number": "1982289625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 PRINTERS PKWY",
            "address_2": "STE 200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809103142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 MINNEQUA AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043734",
            "telephone_number": "719-281-3285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "CALLIE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-15",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0996306-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.