NPIMap

Individual provider Active NPI

Christine A Connolly, MD

  • Family Medicine Physician
  • Cheyenne Wells, CO
National Provider Identifier
1992787840
Registry record updated Jan 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
41473 Issued in CO
Practice address
602 N 6TH Street West
Cheyenne Wells, CO 80810-0578
Phone
(719) 767-5669
Fax
(719) 767-8042
NPI assigned
Nov 16, 2005
Last updated
Jan 6, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2014

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 41473 CO Primary

Addresses

Primary practice location

602 N 6TH Street West
Cheyenne Wells, CO 80810-0578

Mailing address

602 N 6TH Street West
Cheyenne Wells, CO 80810-0578
Phone (719) 767-5669

Other identifiers 2

IdentifierTypeStateIssuer
29639522MedicaidCO
COA106508OtherCOMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040203000888 CO Practitioner - Family Practice 0345133435 Reassigns benefits to 1 organization
I20210208000876 TX Practitioner - Family Practice 0345133435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Questcare Medical Clinics PLLCGroup PAC ID 6608010541, 16 clinicians

Practice addresses (Care Compare)

1571 SW Wilshire Blvd
Suite 500
Burleson, TX 76028-8717
Phone (954) 939-5000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41473COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Questcare Medical Clinics PLLC Family Medicine CurrentSince Dec 1, 2020 Accepting new patients
Keefe Memorial Health Service District CurrentSince Apr 1, 2015 Accepting new patients
Keefe Memorial Health Service District CurrentSince Apr 1, 2015 Accepting new patients
Questcare Medical Clinics PLLC Family Medicine CurrentSince Dec 1, 2020 Accepting new patients
New West Physicians Inc Family Medicine Past Accepting new patients
Questcare Medical Clinics PLLC Family Medicine Past Accepting new patients
Onpoint Medical Group, LLC Family Medicine Past Accepting new patients

Locations

602 N 6th St W
Cheyenne Wls, CO 80810
Phone (719) 767-5661

1571 SW Wilshire Blvd
Ste 500
Burleson, TX 76028
Phone (817) 295-1121

900 8th Ave
Ft Worth, TX 76104
Phone (817) 336-2100

Interoperability endpoints

  • Direct secure messaging: christine.connolly.1@32456.direct.athenahealth.com

Organizations & group practices 7

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 3

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": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388966400000",
    "number": "1992787840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 N 6TH STREET WEST",
            "city": "CHEYENNE WELLS",
            "state": "CO",
            "postal_code": "808100578",
            "telephone_number": "719-767-5669",
            "fax_number": "719-767-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 N 6TH STREET WEST",
            "city": "CHEYENNE WELLS",
            "state": "CO",
            "postal_code": "808100578",
            "telephone_number": "719-767-5669",
            "fax_number": "719-767-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "CHRISTINE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-16",
        "last_updated": "2014-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "41473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "29639522",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "COA106508",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheyenne Wells, CO

Sources for this page

Verify at the official NPI Registry.