NPIMap

Organization Active NPI

Intermountain Medical Group Denver, LLC

  • Family Medicine Physician
  • Lakewood, CO
National Provider Identifier
1992313373
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
Practice address
12790 W Alameda Pkwy Ste a
Lakewood, CO 80228-2850
Phone
(303) 403-6350
Fax
(303) 403-6372
NPI assigned
Jul 21, 2020
Organization subpart
Yes
Parent organization
INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

Authorized official

NPPES NPI Registry
Name
Jon McDaniel
Title
VP of Finance
Phone
(303) 272-0231

Corporate family (same tax ID) 12

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0691762Green Mountain Clinic Primary Care12790 W Alameda Pkwy, Suite a, Lakewood, CO 80228Certificate of waiverFeb 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Intermountain Medical Group Denver LLC (121 organizations share this tax ID)
Part of
Lutheran Medical Center

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Occupational Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083X0100X

Addresses

NPPES NPI Registry

Primary practice location

12790 W Alameda Pkwy Ste a
Lakewood, CO 80228-2850

Mailing address

500 Eldorado Blvd Ste 6300
Broomfield, CO 80021-3422
Phone (303) 272-0566

Other names 1

NPPES NPI Registry
  • Green Mountain Clinic - Primary Care Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 28, 2024.

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1992313373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ELDORADO BLVD STE 6300",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800213422",
            "telephone_number": "303-272-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12790 W ALAMEDA PKWY STE A",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802282850",
            "telephone_number": "303-403-6350",
            "fax_number": "303-403-6372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP DENVER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "enumeration_date": "2020-07-21",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Mountain Clinic - Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.