NPIMap

Individual provider Active NPI

Glenn Jamie Collins, MD

  • Emergency Medicine Physician
  • Pueblo, CO
National Provider Identifier
1992326128
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DR.0073343 Issued in CO
Practice address
400 W 16TH St
Pueblo, CO 81003-2745
Phone
(719) 584-4306
NPI assigned
Apr 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X DR.0073343 CO Primary
Student in an Organized Health Care Education/Training Program 390200000X 999999 CA

Addresses

Primary practice location

400 W 16TH St
Pueblo, CO 81003-2745

Mailing address

PO Box 738380
Dallas, TX 75373-8380

Other practice location 1

101 The City Dr S
Orange, CA 92868-3201
Phone (714) 456-5239

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
I20240815004636 CO Practitioner - Emergency Medicine 7911387709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of California, Irvine, California College of Medicine, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

400 W 16TH St
Pueblo, CO 81003-2745

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.65 of 100Reported as group
Quality
64.78
Improvement activities
40
Cost
70.76

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0073343COMDEmergency Medicine Physician
999999CAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Colorado Emergency Medical Associates Emergency Medicine CurrentSince Apr 1, 2025 Accepting new patients
Southern Colorado Emergency Medical Associates Emergency Medicine CurrentSince Apr 1, 2025 Accepting new patients

Locations

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

899 E Industrial Blvd
Pueblo West, CO 81007
Phone (719) 288-2100

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1588032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1992326128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 738380",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753738380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032745",
            "telephone_number": "719-584-4306"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 The City Dr S",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928683201",
            "country_code": "US",
            "telephone_number": "714-456-5239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "GLENN",
        "middle_name": "JAMIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-28",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "DR.0073343",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "999999",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.