Intermountain Medical Group Denver, LLC
Organization Active NPI Endocrinology, Diabetes & Metabolism Physician · Arvada, CO
NPI 1982434239 · NPPES record last updated Aug 2, 2024
Key facts
- NPI
- 1982434239
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician 207RE0101X
- Legal business name
- INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
- Practice address
- 15389 W 91St Dr Ste 200
Arvada, CO 80007-1400 - Phone
- (303) 403-7933
- Fax
- (303) 403-7945
- NPI assigned
- Aug 2, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- INTERMOUNTAIN FRONT RANGE, INC.
Authorized official
- Name
- Jon McDaniel
- Title
- VP Finance
- Phone
- (303) 272-0231
Corporate family (same tax ID) 13
Practitioners 19
-
Katelyn Burns, D.P.T.
-
Tara Butler, DPT
-
Alexandra Capezzuto, PHYSICIAN ASSISTANT
-
Corinne D Hanisch, PA-C
-
Kelli Hopke, PT, DPT, OCS
-
Chad Michael Lucci, PA-C
-
Kellie Lyons, PA
-
Donald J. May, M.D.
-
Kara D Muma, NNP
-
Lisa Winkler, MD
-
Matthew Niels Hansen, PA-C
-
Jacinto I Manon, MD
-
James B Regan, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150106000131 | CO | Part B Supplier - Clinic/Group Practice | 0840513552 |
Receives reassigned benefits from 1,361 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Intermountain Medical Group Denver LLC
- Part of
- Lutheran Medical Center
Locations
15389 W 91st Dr
Ste 200
Arvada, CO 80007
Phone (303) 403-7933
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian |
133V00000X | |||
| Endocrinology, Diabetes & Metabolism Physician |
207RE0101X | Yes |
Addresses
Primary practice location
15389 W 91St Dr Ste 200
Arvada, CO 80007-1400
Mailing address
500 Eldorado Blvd Ste 4300
Broomfield, CO 80021-3564
Phone (303) 272-0566
Other names
- Candelas Clinic - Diabetes and Endocrinology
Other providers in Arvada, CO
- Inner Door Therapy LLC
- Carleen R Innes
- Integrated Awakening LLC
- Integrated Family Wellness, Training & Consulting
- Intermountain Medical Group Denver, LLC
- Vonda Ioan
- Iora Health Colorado, P.C.
- Iora Senior Health, LLC
- Cynthia J Ireland
- Johanna Isaacs
All providers in Arvada, CO · Endocrinology, Diabetes & Metabolism Physician in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.