| Colorado Clinic | |
|
300 Colorado Ave Pueblo CO 81004-2006 | |
| (719) 543-8711 | |
| (719) 543-5340 |
| Full Name | Colorado Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 300 Colorado Ave, Pueblo, Colorado |
| Authorized Official Name and Position | Donald E Moore (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7195438718 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Colorado Clinic 110 E Routt Ave Pueblo CO 81004-2117 Ph: (719) 543-8718 | Colorado Clinic 300 Colorado Ave Pueblo CO 81004-2006 Ph: (719) 543-8711 |
| NPI Number | 1770529950 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 08/28/2013 |
| Medicare PECOS PAC ID | 4284543802 |
|---|---|
| Medicare Enrollment ID | O20031104000171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770529950 | NPI | - | NPPES |
| 05638275 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0849 (Colorado) | Primary |
| Provider Name | Joy J Furman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184650525 PECOS PAC ID: 1254235575 Enrollment ID: I20031119000931 |
| Provider Name | Richard N King |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679500599 PECOS PAC ID: 2769461664 Enrollment ID: I20040715000149 |
| Provider Name | James E Roukema |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1891714713 PECOS PAC ID: 6406827609 Enrollment ID: I20040802001654 |
| Provider Name | Cynthia C Jimenez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902920564 PECOS PAC ID: 0042259624 Enrollment ID: I20050503000632 |
| Provider Name | Alfredo Vargas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396753521 PECOS PAC ID: 2668404450 Enrollment ID: I20050831000925 |
| Provider Name | Patricia Susana Sabatini |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1730142613 PECOS PAC ID: 5092749572 Enrollment ID: I20051020000738 |
| Provider Name | Steven D Nafziger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043442791 PECOS PAC ID: 8527088541 Enrollment ID: I20051205000745 |
| Provider Name | Lucinda Diane Stegman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265403901 PECOS PAC ID: 4981619970 Enrollment ID: I20060213000357 |
| Provider Name | Thomas B Clemens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427085323 PECOS PAC ID: 7012924301 Enrollment ID: I20060310000467 |
| Provider Name | Cheryl L Wegelin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124150883 PECOS PAC ID: 2163431909 Enrollment ID: I20060406000292 |
| Provider Name | Michele Z Pennington |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275624850 PECOS PAC ID: 8325045941 Enrollment ID: I20061024000529 |
| Provider Name | Lynne M Evetts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023054541 PECOS PAC ID: 6305942780 Enrollment ID: I20070501000428 |
| Provider Name | Michael Barris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386671204 PECOS PAC ID: 9032203559 Enrollment ID: I20070914000332 |
| Provider Name | Jill Pollock |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376614784 PECOS PAC ID: 0042394728 Enrollment ID: I20080220000396 |
| Provider Name | Brian A Bentz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487851010 PECOS PAC ID: 8224107982 Enrollment ID: I20080521000123 |
| Provider Name | Megan M Lenhart |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386781656 PECOS PAC ID: 4183783467 Enrollment ID: I20081030000826 |
| Provider Name | Sergio Alberto Murillo Herrera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598923757 PECOS PAC ID: 3870653348 Enrollment ID: I20081114000371 |
| Provider Name | Michael O Growney |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1851437636 PECOS PAC ID: 2860453321 Enrollment ID: I20090127000452 |
| Provider Name | Rona K Knudsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740216878 PECOS PAC ID: 9830255090 Enrollment ID: I20090313000105 |
| Provider Name | Brett L Hulet |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1447245139 PECOS PAC ID: 2163519885 Enrollment ID: I20090316000468 |
| Provider Name | Joseph W Castelli |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1689646812 PECOS PAC ID: 1355422916 Enrollment ID: I20090915000514 |
| Provider Name | Dana G Riley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073540910 PECOS PAC ID: 8224178983 Enrollment ID: I20091210000750 |
| Provider Name | David Krause |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659308575 PECOS PAC ID: 9133200652 Enrollment ID: I20091210000760 |
| Provider Name | Mark D Schwartz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881622629 PECOS PAC ID: 2961542543 Enrollment ID: I20091211000274 |
| Provider Name | Donna R Lagrotteria |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508894346 PECOS PAC ID: 3476693441 Enrollment ID: I20091223000140 |
| Provider Name | Sara Tonsing |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1598750291 PECOS PAC ID: 5395874606 Enrollment ID: I20100525000822 |
| Provider Name | Fernando Ariel Mahmoud |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1245542471 PECOS PAC ID: 7719176841 Enrollment ID: I20110105000736 |
| Provider Name | Robert N Alsever |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1780667972 PECOS PAC ID: 0143408245 Enrollment ID: I20110620000357 |
| Provider Name | Regina J Griego |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710274394 PECOS PAC ID: 0446422166 Enrollment ID: I20110930000298 |
| Provider Name | Mary Hund-snyder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376538082 PECOS PAC ID: 2062670128 Enrollment ID: I20120221000039 |
| Provider Name | Donald J Higdon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154482610 PECOS PAC ID: 4880853308 Enrollment ID: I20120301000870 |
| Provider Name | Prudencio A Cosyleon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083775498 PECOS PAC ID: 2961661038 Enrollment ID: I20120312000323 |
| Provider Name | Michael A Ramos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699743724 PECOS PAC ID: 2062673197 Enrollment ID: I20120416000814 |
| Provider Name | Jeanette Janine Grant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356610901 PECOS PAC ID: 3072777861 Enrollment ID: I20120606000676 |
| Provider Name | Stephanie Parker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538135561 PECOS PAC ID: 4082664149 Enrollment ID: I20120709000225 |
| Provider Name | Maria Cramer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902916794 PECOS PAC ID: 5597760363 Enrollment ID: I20120716000439 |
| Provider Name | Sudheshna Ropp |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1689683054 PECOS PAC ID: 7517113087 Enrollment ID: I20120816000298 |
| Provider Name | Emillia Cristina Ortiz Lloyd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578630885 PECOS PAC ID: 4183778228 Enrollment ID: I20130816000476 |
| Provider Name | Leslie Dabovich Dempsey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225349202 PECOS PAC ID: 2466696554 Enrollment ID: I20130911000171 |
| Provider Name | Patricia D Quillen |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1134256787 PECOS PAC ID: 5799929584 Enrollment ID: I20130917000733 |
| Provider Name | Lynn Leyba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891721437 PECOS PAC ID: 4981838133 Enrollment ID: I20131002000213 |
| Provider Name | Maria L Duran-shy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275833667 PECOS PAC ID: 0345475372 Enrollment ID: I20131030000036 |
| Provider Name | Wendy Raso |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1700821469 PECOS PAC ID: 5597990481 Enrollment ID: I20131031000458 |
| Provider Name | Paulina Adjei |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427482884 PECOS PAC ID: 9032345921 Enrollment ID: I20131125000594 |
| Provider Name | Virginia C Gillispie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730216771 PECOS PAC ID: 3971720392 Enrollment ID: I20140808000721 |
| Provider Name | Rachel C Niemet |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1326366105 PECOS PAC ID: 4587803325 Enrollment ID: I20140912001102 |
| Provider Name | Kristine Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598927931 PECOS PAC ID: 1557535952 Enrollment ID: I20141021000319 |
| Provider Name | Kristi Lynn Meyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275718215 PECOS PAC ID: 8527249390 Enrollment ID: I20141231000513 |
| Provider Name | Regan A Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871918037 PECOS PAC ID: 8123345394 Enrollment ID: I20150327000362 |
| Provider Name | Svetlana Naymark |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1427346139 PECOS PAC ID: 7416268917 Enrollment ID: I20150625000369 |
| Provider Name | Charmayne Noel Sandoval |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215221320 PECOS PAC ID: 8527373760 Enrollment ID: I20150817001419 |
| Provider Name | Alyssa June Mcclurg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639316003 PECOS PAC ID: 5496062218 Enrollment ID: I20150911000026 |
| Provider Name | Aileen Nunag Carlos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033591714 PECOS PAC ID: 8123338670 Enrollment ID: I20151112001726 |
| Provider Name | Shelby Lindsay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548671613 PECOS PAC ID: 4183928641 Enrollment ID: I20160204000666 |
| Provider Name | Justin V Diegel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497193718 PECOS PAC ID: 0143524009 Enrollment ID: I20160212001875 |
| Provider Name | Jennifer Gallegos |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1457716755 PECOS PAC ID: 7214232255 Enrollment ID: I20160229002031 |
| Provider Name | Brian R Juan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669887360 PECOS PAC ID: 9739484635 Enrollment ID: I20160301001100 |
| Provider Name | Amy R Ochle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164888400 PECOS PAC ID: 6800195389 Enrollment ID: I20160504002746 |
| Provider Name | Shaundra M Lujan |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1518323955 PECOS PAC ID: 8123319688 Enrollment ID: I20160614001519 |
| Provider Name | Timothy Papsidero |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770920969 PECOS PAC ID: 0244520096 Enrollment ID: I20160728001791 |
| Provider Name | Kelsey L Markenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275085086 PECOS PAC ID: 8426338443 Enrollment ID: I20161209000362 |
| Provider Name | Alethea Hoewisch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043754880 PECOS PAC ID: 7618244054 Enrollment ID: I20170606001946 |
| Provider Name | Courtney M Fugate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962782037 PECOS PAC ID: 4587834338 Enrollment ID: I20170626000384 |
| Provider Name | Adam Randall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639626997 PECOS PAC ID: 0244506988 Enrollment ID: I20171109003068 |
| Provider Name | Nicole Bower |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205230778 PECOS PAC ID: 8123384740 Enrollment ID: I20171114001917 |
| Provider Name | Robert L Johnson |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1366410425 PECOS PAC ID: 1557304359 Enrollment ID: I20171114002739 |
| Provider Name | Maria Lengele |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1982146221 PECOS PAC ID: 9931465507 Enrollment ID: I20171115000045 |
| Provider Name | Elizabeth Louise Stuyt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619905049 PECOS PAC ID: 2567728165 Enrollment ID: I20171115001590 |
| Provider Name | Dana Alice Zuidema |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649797804 PECOS PAC ID: 9234496654 Enrollment ID: I20171120001931 |
| Provider Name | Maranda D Ray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841745601 PECOS PAC ID: 5890083232 Enrollment ID: I20171201000967 |
| Provider Name | Ashlie Davenport |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679083695 PECOS PAC ID: 1052679776 Enrollment ID: I20171228002779 |
| Provider Name | Carly A Lacroix |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1316328560 PECOS PAC ID: 4688981319 Enrollment ID: I20180207000891 |
| Provider Name | Matthew T Mejia |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851507321 PECOS PAC ID: 2668727389 Enrollment ID: I20180621001198 |
| Provider Name | Breanna Rene Berry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457615189 PECOS PAC ID: 4284876491 Enrollment ID: I20180625002178 |
| Provider Name | Samuel George Longfellow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851771943 PECOS PAC ID: 9830445196 Enrollment ID: I20180629000647 |
| Provider Name | Susanna Maria Jacobs |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1750792313 PECOS PAC ID: 9638425200 Enrollment ID: I20180712000653 |
| Provider Name | Jill Hollar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093173833 PECOS PAC ID: 9335497049 Enrollment ID: I20180810002745 |
| Provider Name | Claire H Reed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366474850 PECOS PAC ID: 6608882642 Enrollment ID: I20180925001895 |
| Provider Name | Lisa M Rich |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1164906194 PECOS PAC ID: 2365795424 Enrollment ID: I20181019001605 |
| Provider Name | Harmeet Singh Dhaliwal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831572106 PECOS PAC ID: 1355695313 Enrollment ID: I20181112001226 |
| Provider Name | Stephanie Nicole Payne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518318039 PECOS PAC ID: 4486991718 Enrollment ID: I20190124002674 |
| Provider Name | Jesusita Elvira Tafoya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225543945 PECOS PAC ID: 6204173354 Enrollment ID: I20190128001099 |
| Provider Name | Kendra Fejedelem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053889014 PECOS PAC ID: 4385977503 Enrollment ID: I20190603002377 |
| Provider Name | Akoua Attiogbe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346768868 PECOS PAC ID: 3173857513 Enrollment ID: I20190619000604 |
| Provider Name | Christina M Wooters-eck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659935401 PECOS PAC ID: 3375877582 Enrollment ID: I20190621001468 |
| Provider Name | Nathan James Culberson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598150963 PECOS PAC ID: 0042592271 Enrollment ID: I20190819003435 |
| Provider Name | Cynthia Renee Fallhowe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730365495 PECOS PAC ID: 9335497247 Enrollment ID: I20190920001693 |
| Provider Name | Liberty Angel Ruiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700445467 PECOS PAC ID: 5597097329 Enrollment ID: I20191029001260 |
| Provider Name | Todd Odegaard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427584531 PECOS PAC ID: 4183993983 Enrollment ID: I20191121000413 |
| Provider Name | Kelsey Bohr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851946818 PECOS PAC ID: 6800229576 Enrollment ID: I20191211000350 |
| Provider Name | Jennifer D Vail |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1225678261 PECOS PAC ID: 2961838289 Enrollment ID: I20200205001597 |
| Provider Name | Martin W Chrisman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497391643 PECOS PAC ID: 3870921422 Enrollment ID: I20200316000221 |
| Provider Name | Bonnie J Henderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841454352 PECOS PAC ID: 6709189244 Enrollment ID: I20200317002186 |
| Provider Name | Brandi L Trujillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902435506 PECOS PAC ID: 1951732569 Enrollment ID: I20200515000421 |
| Provider Name | Cassandra Jean Balon |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1548624992 PECOS PAC ID: 8123396306 Enrollment ID: I20200903001077 |
| Provider Name | Melissa M Lesavoy |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1750775102 PECOS PAC ID: 8123446432 Enrollment ID: I20200918001425 |
| Provider Name | Christi Lyn Bader |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487279659 PECOS PAC ID: 1759700388 Enrollment ID: I20201001001437 |
| Provider Name | Julie Tenbrook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164417606 PECOS PAC ID: 6709876279 Enrollment ID: I20201104002895 |
| Provider Name | Meghan Stich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669828141 PECOS PAC ID: 2365794971 Enrollment ID: I20201202000591 |
| Provider Name | Kimberly A Mahoney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235456393 PECOS PAC ID: 7113330630 Enrollment ID: I20201230000773 |
| Provider Name | Marcella Antoinette Masterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811591852 PECOS PAC ID: 9032528922 Enrollment ID: I20210505001598 |
| Provider Name | Erika L Willetts |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1235507310 PECOS PAC ID: 8224346457 Enrollment ID: I20210616000357 |
| Provider Name | Mayline Michelle Nambela-barlow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245734136 PECOS PAC ID: 3173921830 Enrollment ID: I20211011000514 |
| Provider Name | Clare Arth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518984475 PECOS PAC ID: 5092785519 Enrollment ID: I20211104000251 |
| Provider Name | Kimberly A Pallazola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164180667 PECOS PAC ID: 0941691786 Enrollment ID: I20220105000816 |
| Provider Name | Diana S Pacheco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316695059 PECOS PAC ID: 7618362849 Enrollment ID: I20220324001583 |
| Provider Name | Nicole M Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972247138 PECOS PAC ID: 7719364603 Enrollment ID: I20220516000277 |
| Provider Name | Deborah Ruth Shaffer |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1326647959 PECOS PAC ID: 7517370190 Enrollment ID: I20220726001990 |
| Provider Name | Audra Anne Hazel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336886324 PECOS PAC ID: 5799167425 Enrollment ID: I20220727004348 |
| Provider Name | Laura Michelle Grunewald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144956251 PECOS PAC ID: 3476937350 Enrollment ID: I20220825003243 |
| Provider Name | Alvin Si-long Tang |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1487318721 PECOS PAC ID: 9032595103 Enrollment ID: I20220928000542 |
| Provider Name | Darcy Victoria- Faye Heim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649934894 PECOS PAC ID: 4385020049 Enrollment ID: I20221004000011 |
| Provider Name | Melissa A Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073145181 PECOS PAC ID: 0749656072 Enrollment ID: I20221012000008 |
| Provider Name | Kelly Celeste Mclean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154956530 PECOS PAC ID: 8527434877 Enrollment ID: I20221012001172 |
| Provider Name | Casey Anna Fuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568997757 PECOS PAC ID: 5799107926 Enrollment ID: I20221123000869 |
| Provider Name | William Edward Mead |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154734424 PECOS PAC ID: 3577933654 Enrollment ID: I20230105003107 |
| Provider Name | Julie Ann Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679709000 PECOS PAC ID: 0042681876 Enrollment ID: I20230113001690 |
| Provider Name | Tsomorlog Austin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184338147 PECOS PAC ID: 5092188607 Enrollment ID: I20230302000070 |
| Provider Name | Samantha Jo Frankmore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851099360 PECOS PAC ID: 3274908264 Enrollment ID: I20230404002745 |
| Provider Name | Anna Fernandez |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1386878007 PECOS PAC ID: 8921464371 Enrollment ID: I20230510001077 |
| Provider Name | Danyel R Baker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588222020 PECOS PAC ID: 4981930310 Enrollment ID: I20230705001462 |
| Provider Name | Christopher S Rothschild |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174200745 PECOS PAC ID: 4981067048 Enrollment ID: I20230823001541 |
| Provider Name | Carrie Neumann |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124249586 PECOS PAC ID: 3173972601 Enrollment ID: I20231209000760 |
| Provider Name | Tracey Lynn Clark |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215479415 PECOS PAC ID: 5193174571 Enrollment ID: I20231211001558 |
| Provider Name | Jill Finegold |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548426299 PECOS PAC ID: 4486003696 Enrollment ID: I20231213003234 |
| Provider Name | Mindy Jean Armijo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356507107 PECOS PAC ID: 1456700673 Enrollment ID: I20231213003823 |
| Provider Name | Jeanne Lee Walsh |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801331517 PECOS PAC ID: 3375992365 Enrollment ID: I20231215003022 |
| Provider Name | Denise L Kidd |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174852750 PECOS PAC ID: 3678923497 Enrollment ID: I20231220001013 |
| Provider Name | Karen Ann Faulk |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1437492204 PECOS PAC ID: 7315397544 Enrollment ID: I20231229000869 |
| Provider Name | Nora Patricia Elizalde |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1366851313 PECOS PAC ID: 7315246055 Enrollment ID: I20231229001246 |
| Provider Name | Eva Nunez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588988802 PECOS PAC ID: 1052761061 Enrollment ID: I20240103000133 |
| Provider Name | Gloriean Ortiz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902290927 PECOS PAC ID: 7517318991 Enrollment ID: I20240110002160 |
| Provider Name | Jodi Ann Kurz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356123442 PECOS PAC ID: 8325490410 Enrollment ID: I20240112004047 |
| Provider Name | Norma J Nehren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063408359 PECOS PAC ID: 5092706713 Enrollment ID: I20240119002583 |
| Provider Name | Cassandra Holly Furlong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700657418 PECOS PAC ID: 6507203080 Enrollment ID: I20240319003936 |
| Provider Name | Sherry Allison Hunter |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1497273767 PECOS PAC ID: 2062775778 Enrollment ID: I20240405001521 |
Lake Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2001 Lake Ave, Pueblo, CO 81004 Phone: 719-564-0300 Fax: 719-564-0303 | |
Risley School Based Wellness Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 625 N Monument Ave, Pueblo, CO 81001 Phone: 719-543-8711 Fax: 719-543-5340 | |
Digestive Diseases Specialists Of Colorado,llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1600 N Grand Ave, Suite 440, Pueblo, CO 81003 Phone: 719-543-3500 Fax: 719-543-3504 | |
Parkview Ancillary Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 525 West 15th Street, Ste. 300, Pueblo, CO 81003 Phone: 719-542-1696 Fax: 719-542-1698 | |
Concentra Urgent Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4117 N Elizabeth St, Pueblo, CO 81008 Phone: 719-545-0788 | |
Front Range Clinic Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1249 E Routt Ave, Pueblo, CO 81004 Phone: 720-808-0051 | |
Health Solutions Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1302 Chinook Ln, Pueblo, CO 81001 Phone: 719-545-2746 |