POUDRE VALLEY MEDICAL GROUP, LLC (NPI# 1528699113) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528699113 |
| Entity Type | Organization |
| Organization Name | POUDRE VALLEY MEDICAL GROUP, LLC |
| Practice Address |
505 S Burg St Kimball NE 69145-1313 |
| Mailing Address |
2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 |
| Practice Telephone | 3082351953 |
| Practice Fax Number | 3082351956 |
| Mailing Telephone | 3082351953 |
| Mailing Fax Number | 3082351956 |
| Enumeration Date | 2020-02-01 |
| Last Update Date | 2020-02-01 |
| Authorized Official Name | JANA CONROY (CREDENTIALING MANAGER) |
| Authorized Official Telephone | 9706244443 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| UCHealth Heart and Vascular Clinic - Kimball | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350476 | Poudre Valley Medical Group, LLC | Urology | 2315 E Harmony Rd Ste 140, Fort Collins, CO 80528-8620 | 2020-09-15 |
| 1699389353 | Poudre Valley Medical Group, LLC | Internal Medicine | 5818 N Nevada Ave, Suite 225, Colorado Springs, CO 80918 | 2020-09-01 |
| 1700490455 | Poudre Valley Medical Group, LLC | Radiology | 4080 Briargate Parkway, Colorado Springs, CO 80920 | 2020-09-01 |
| 1134732209 | Poudre Valley Medical Group, LLC | Physical Medicine & Rehabilitation | 5818 N Nevada Avenue, Suite 225, Colorado Springs, CO 80918 | 2020-08-28 |
| 1104439322 | Poudre Valley Medical Group, LLC | Radiology | 525 Bob Peters Grv Ste 100, Colorado Springs, CO 80909-4533 | 2020-08-27 |
| 1932712155 | Poudre Valley Medical Group, LLC | Internal Medicine | 940 Central Park Dr Ste 290, Steamboat Springs, CO 80487-8853 | 2020-08-27 |
| 1033722376 | Poudre Valley Medical Group, LLC | Family Medicine | 15854 Jackson Creek Pkwy Unit 120, Monument, CO 80132-8663 | 2020-08-26 |
| 1285247866 | Poudre Valley Medical Group, LLC | Physical Therapist | 6767 29th St Fl 1, Greeley, CO 80634-5474 | 2020-08-25 |
| 1932711868 | Poudre Valley Medical Group, LLC | Obstetrics & Gynecology | 100 Cook St Ste 210, Denver, CO 80206-5328 | 2020-08-21 |
| 1619586187 | Poudre Valley Medical Group, LLC | Urology | 175 S Union Blvd Ste 315, Colorado Springs, CO 80910-3126 | 2020-07-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Poudre Valley Medical Group, LLC | 2695 Rocky Mountain Ave., Suite 110, Loveland, CO 80538 |
| Street Address |
505 S BURG ST |
| City | KIMBALL |
| State | NE |
| Zip Code | 69145-1313 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720067556 | Gayle L Perkins | Physician Assistant | 505 S Burg St, Kimball, NE 69145 | 2006-01-11 |
| 1578038063 | Kirk Alan Evertson | Physical Therapist | 505 S Burg St, Kimball, NE 69145-1313 | 2018-10-10 |
| 1629575345 | Jaimie C Dirks | Nurse Practitioner | 505 S Burg St, Kimball, NE 69145-1313 | 2018-04-09 |
| 1871889865 | Elizabeth Ann Kenyon | Dietitian, Registered | 505 S Burg St, Kimball, NE 69145-1313 | 2011-06-28 |
| 1588893317 | Holly Faye Dobrinski | Nurse Practitioner | 505 S Burg St, Kimball, NE 69145-1313 | 2009-07-14 |
| 1386846525 | Lisa M Smith-schohl | Physician Assistant | 505 S Burg St, Kimball, NE 69145 | 2007-06-01 |
| 1942380431 | Trevor Wright Bush | Family Medicine | 505 S Burg St, Kimball, NE 69145-1313 | 2006-10-17 |
| 1235237975 | James Floid Broomfield | Family Medicine | 505 S Burg St, Kimball, NE 69145-1313 | 2006-09-20 |
| 1184728537 | William Joseph Wyatt | Plastic Surgery | 505 S Burg St, Kimball, NE 69145-1313 | 2006-09-07 |
| 1669447223 | Kimball County Hospital | General Acute Care Hospital | 505 S Burg St, Kimball, NE 69145-1313 | 2006-02-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164843504 | Christine Ellen Douglas | Dietitian, Registered | 505 S. Burg Street, Kimball Health Services At, Kimball, NE 69145 | 2014-01-03 |
| 1720004674 | Bemis Drug LLC | Durable Medical Equipment & Medical Supplies | 129 S. Chestnut Street, Kimball, NE 69145 | 2006-07-14 |
| 1295169050 | Jordan A Autrey | Pharmacist | 129 S. Chestnut Street, Kimball, NE 69145 | 2013-08-29 |
| 1891246914 | Highpoint Family Medicine LLC | Family Medicine | 111 E 2nd St, Kimball, NE 69145-1208 | 2016-10-24 |
| 1639413941 | Highpoint Spine and Joint Center, P.C. | Chiropractor | 111 E 2nd St, Kimball, NE 69145-1208 | 2012-11-27 |
| 1669709879 | Ryan Michael Behrend | Chiropractor | 111 E 2nd St, Kimball, NE 69145-1208 | 2009-11-09 |
| 1417339821 | Panhandle Mental Health Center | Community/Behavioral Health | 414 W 2nd St, Kimball, NE 69145-1247 | 2015-06-22 |
| 1245440528 | Kimball Family Dentistry P.C. | Dentist | 416 W 2nd St, Kimball, NE 69145-1247 | 2007-05-23 |
| 1780932897 | Adrian Lee Fuss | Dentist | 416 W 2nd St, Kimball, NE 69145-1247 | 2012-08-21 |
| 1932238714 | Walker Pharmacy Inc | Pharmacy | 129 S Chestnut St, Kimball, NE 69145-1256 | 2007-03-05 |
| Find all providers in zip 69145 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750903068 | Matrix Medical Network of Nebraska PC | Internal Medicine | 233 S 13th St Ste 1900, Lincoln, NE 68508-2000 | 2020-05-08 |
| 1700417391 | Poudre Valley Medical Group, LLC | Internal Medicine | 2 W 42nd St Ste 2200, Scottsbluff, NE 69361-4669 | 2020-02-01 |
| 1467906487 | Arif Ishaq Albulushi | Internal Medicine | 9011 Burt St, Apt 106, Omaha, NE 68114-2477 | 2016-08-08 |
| 1578796207 | Krishna Naag Velagapudi | Internal Medicine | 110 N 29th St Ste 301, Norfolk, NE 68701-4466 | 2009-08-28 |
| 1639333883 | James N Karnegis | Internal Medicine | 20975 Bonanza Blvd, Elkhorn, NE 68022-1838 | 2008-07-16 |
| 1780725580 | Richard James Markiewicz | Internal Medicine | 601 W Leota St., North Platte, NE 69101 | 2007-02-12 |
| 1912055112 | Hemantha Kumar Koduri | Internal Medicine | 4445 S 86th St Ste 100, Lincoln, NE 68526 | 2007-01-06 |
| 1316025505 | Robert Lee Percell Jr. | Internal Medicine | 1600 S 48th St Ste 600, Lincoln, NE 68506-1275 | 2006-11-02 |
| 1861503427 | Antonio P Reyes | Internal Medicine | 4239 Farnam St Ste 100, Omaha, NE 68131-2858 | 2006-08-31 |
| 1184739989 | Dennis J Esterbrooks | Internal Medicine | 2412 Cuming St, Omaha, NE 68131-1601 | 2006-08-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.