NPIMap

Individual provider Active NPI

Tish R Landrum, MD

  • Family Medicine Physician
  • Wheat Ridge, CO
National Provider Identifier
1982706727
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
33760 Issued in CO
Practice address
8550 W 38TH Ave
Suite 206
Wheat Ridge, CO 80033-4300
Phone
(303) 953-7700
Fax
(303) 456-6734
NPI assigned
Sep 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 33760 CO Primary

Addresses

Primary practice location

8550 W 38TH Ave
Suite 206
Wheat Ridge, CO 80033-4300

Mailing address

8550 W 38TH Ave
Suite 206
Wheat Ridge, CO 80033-4300
Phone (303) 953-7700

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
I20101222000890 CO Practitioner - Family Practice 2163565474 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

Broomfield, CO 80021
Phone (720) 807-4461

1726 Cole Blvd
Suite 350
Golden, CO 80401-3213
Phone (303) 403-7381

22 S Adams St
Denver, CO 80209-2908
Phone (303) 321-2452

8350 Colorado Blvd
Unit 160
Firestone, CO 80504-6803
Phone (303) 673-1370

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33760COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Denver, LLC Family Medicine Current Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Mar 1, 2017 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Mar 1, 2017 Accepting new patients
Intermountain Front Range, Inc. Past Accepting new patients
New West Physicians Inc Family Medicine Past Accepting new patients
Elane Shirar MD Inc Family Medicine PastSince Nov 1, 1999 Accepting new patients
Intermountain Front Range, Inc. Family Medicine Past Accepting new patients

Locations

1726 Cole Blvd
Ste 350
Lakewood, CO 80401
Phone (303) 403-7381

Organizations & group practices 8

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": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194912000000",
    "number": "1982706727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8550 W 38TH AVE",
            "address_2": "SUITE 206",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800334300",
            "telephone_number": "303-953-7700",
            "fax_number": "303-456-6734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8550 W 38TH AVE",
            "address_2": "SUITE 206",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800334300",
            "telephone_number": "303-953-7700",
            "fax_number": "303-456-6734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDRUM",
        "first_name": "TISH",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2007-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "33760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheat Ridge, CO

Sources for this page

Verify at the official NPI Registry.