NPIMap

Organization Active NPI

Catholic Health Initiatives Colorado

Doing business as Centura Health Physician Group Primary Care Broadmoor

  • Family Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1992171219
Registry record updated Apr 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CATHOLIC HEALTH INITIATIVES COLORADO
Doing business as
Centura Health Physician Group Primary Care Broadmoor
Practice address
1263 Lake Plaza Dr
Suite 230
Colorado Springs, CO 80906-3564
Phone
(719) 776-3300
Fax
(719) 776-3329
NPI assigned
Aug 20, 2015
Last updated
Apr 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2016

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

Authorized official

Name
Angela Skinner
Title
Oma / Administrator
Phone
(303) 673-7175

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1263 Lake Plaza Dr
Suite 230
Colorado Springs, CO 80906-3564

Mailing address

PO Box 911057
Denver, CO 80291-1057
Phone (303) 643-1099

Other identifiers 1

IdentifierTypeStateIssuer
50830058MedicaidCO

Other names 1

  • Centura Health Physician Group Primary Care Broadmoor Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031215000462 CO Part B Supplier - Clinic/Group Practice 8022927342 Receives reassigned benefits from 1,310 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Catholic Health Initiatives321 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Practitioners & affiliated clinicians

Practitioners 10

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": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461110400000",
    "number": "1992171219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 911057",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802911057",
            "telephone_number": "303-643-1099",
            "fax_number": "303-643-1176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1263 LAKE PLAZA DR",
            "address_2": "SUITE 230",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063564",
            "telephone_number": "719-776-3300",
            "fax_number": "719-776-3329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CATHOLIC HEALTH INITIATIVES COLORADO",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2016-04-20",
        "status": "A",
        "authorized_official_last_name": "SKINNER",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "OMA / ADMINISTRATOR",
        "authorized_official_telephone_number": "303-673-7175"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50830058",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centura Health Physician Group Primary Care Broadmoor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; 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.