FORM MEDICAL, PLLC (NPI# 1831616390) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831616390 |
| Entity Type | Organization |
| Organization Name | FORM MEDICAL, PLLC |
| Other Organization Name | FORM MEDICAL |
| Practice Address |
1525 Raleigh St Ste 220 Denver CO 80204-1374 |
| Practice Telephone | (720) 370-9559 |
| Mailing Telephone | 7203709559 |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2017-08-25 |
| Authorized Official Name | DR. JESSICA KELNER (PHYSICIAN/MANAGER) |
| Authorized Official Telephone | 7203709559 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081N0008X |
Physical Medicine & Rehabilitation Specialization: Neuromuscular Medicine |
DR.0058123 | CO | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| FORM Medical | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | FORM Medical, PLLC | 1525 Raleigh Street, Suite 300, Denver, CO 80204 |
| Street Address |
1525 RALEIGH ST STE 220 |
| City | DENVER |
| State | CO |
| Zip Code | 80204-1374 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205483716 | Pam Specialty Hospital of Denver LLC | Long Term Care Hospital | 1690 N Meade St, Denver, CO 80204 | 2019-08-20 |
| 1912468125 | Rachel Vanderwel | Student in an Organized Health Care Education/Training Program | 777 Bancock Street, Mc 0108, Denver, CO 80204 | 2019-03-29 |
| 1831673391 | Alexandra Wilcox | Counselor | 1175 Osage St, Suite 205, Denver, CO 80204 | 2018-09-20 |
| 1912480716 | Arieye, Inc | Ophthalmology | 3120 W 19th Ave, Unit 3, Denver, CO 80204 | 2018-09-08 |
| 1144701053 | Kristina Ann Petrosino | Dental Hygienist | 601 Broadway St., Denver, CO 80204 | 2018-08-28 |
| 1811474075 | Lindsey Spraker | Counselor | 1175 Osage Street, Suite 205, Denver, CO 80204 | 2018-07-20 |
| 1427541887 | Healthy Life Care LLC | Home Health | 500 Newton St, Denver, CO 80204 | 2018-06-11 |
| 1932601655 | Emily Gispert Weaver | Student in an Organized Health Care Education/Training Program | 301 W. 6th Ave., Denver, CO 80204 | 2018-03-08 |
| 1144745928 | Melisssa Wells | Licensed Practical Nurse | 1801 W. 13th Ave, Denver, CO 80204 | 2017-08-14 |
| 1689112948 | Tyler Stephens | Student in an Organized Health Care Education/Training Program | 2233 Champa St., Denver, CO 80204 | 2017-02-07 |
| Find all providers in zip 80204 | ||||
| Taxonomy Code | 2081N0008X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Neuromuscular Medicine |
| A physician who specializes in neuromuscular medicine possesses specialized knowledge in the science, clinical evaluation and management of these disorders. This encompasses the knowledge of the pathology, diagnosis and treatment of these disorders at a level that is significantly beyond the training and knowledge expected of a general neurologist, child neurologist or physiatrist. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: new] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427523398 | Krystyna Adair Holland | Physical Medicine & Rehabilitation | 121 S Madison St Ste D, Denver, CO 80209-3019 | 2018-10-08 |
| 1063806602 | Jane Keys | Physical Medicine & Rehabilitation | 1720 S Bellaire St Ste 406, Denver, CO 80222-4312 | 2015-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083087282 | Shawn Alexander Miller | Physical Medicine & Rehabilitation | 822 Carriage Dr, Milliken, CO 80543-3099 | 2015-11-10 |
| 1760878201 | Christina Wilson | Physical Medicine & Rehabilitation | 1618 W Colorado Ave, Colorado Springs, CO 80904-4029 | 2015-04-11 |
| 1366787178 | Courtney Kiser Klataske | Physical Medicine & Rehabilitation | 5387 Lighthouse Point Ct, Loveland, CO 80537-7917 | 2012-12-05 |
| 1568418986 | Gregory Norman Arends | Physical Medicine & Rehabilitation | 1155 Alpine Ave., Ste. 280, Boulder, CO 80304 | 2006-05-26 |
| 1023314234 | Abundant Healthcare, Pllc | Physical Medicine & Rehabilitation | 5630 N Academy Blvd, Colorado Springs, CO 80918-3659 | 2011-02-04 |
| 1962485235 | Raymond P Vandenhoven | Physical Medicine & Rehabilitation | 2500 E Prospect Rd, Fort Collins, CO 80525-9718 | 2005-11-21 |
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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.