21ST MEDICAL GROUP (NPI# 1942286224) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942286224 |
| Entity Type | Organization |
| Organization Name | 21ST MEDICAL GROUP |
| Other Organization Name | PETERSON AFB MTF |
| Practice Address |
559 Vincent St Peterson Afb CO 80914-1541 |
| Practice Telephone | 7195561250 |
| Mailing Telephone | 7195561250 |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2014-02-20 |
| Authorized Official Name | THERESA MARIE MITCHELL (AIR FORCE UBO ANALYST) |
| Authorized Official Telephone | 7036817613 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities | ||
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | NPPES | 1548369259 | 01 |
| CO | NCPDP | 06-16788 | 01 |
| Other Name | Type Code |
|---|---|
| Peterson AFB MTF | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285012922 | 21st Medical Group | Military/U.S. Coast Guard Pharmacy | 220 Falcon Pkwy Bldg 220, Colorado Springs, CO 80912-5005 | 2015-05-14 |
| 1932514171 | 21st Medical Group | Pharmacy | 110 W Ent Ave, Peterson Afb, CO 80914-1595 | 2014-06-26 |
| 1487069621 | 21st Medical Group | Military/U.S. Coast Guard Pharmacy | 220 Falcon Pkwy, Schriever Afb, CO 80912-5005 | 2014-06-26 |
| 1548369259 | 21st Medical Group | Pharmacy | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2006-09-21 |
| Street Address |
559 VINCENT ST |
| City | PETERSON AFB |
| State | CO |
| Zip Code | 80914-1541 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891797080 | Keith Andrew Baker | Family Medicine | 559 Vincent St, 21 Mdos/sgof -fam Hlth, Peterson Afb, CO 80914-1540 | 2005-06-01 |
| 1912475740 | Julian G Fiorina | Family Medicine | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-11-09 |
| 1740776970 | Chelsea M. Cruz | Nurse Practitioner | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-07-11 |
| 1376036665 | Emillie Claire Brandt | Dentist | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-06-11 |
| 1164911053 | Renee Antoinette Smith | Dentist | 559 Vincent St, Peterson Afb, CO 80914-1540 | 2018-05-07 |
| 1720582448 | Cristina Cosner | Military Health Care Provider | 559 Vincent St, Attn: 21 Mdos/sgof - Flight Med, Peterson Afb, CO 80914-1540 | 2018-03-19 |
| 1619476504 | Clarissa Reno | Registered Nurse | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-02-06 |
| 1891159463 | Tialicka Burgos Johnson | Registered Nurse | 559 Vincent St, Attn: 21 Mdos/sgog - Women's Health, Peterson Afb, CO 80914-1540 | 2016-04-11 |
| 1114385747 | Jeffrey A Turner | Physical Therapist | 559 Vincent St, Attn: 21 Mdos/sgoy - Physical Therapy, Peterson Afb, CO 80914-1540 | 2016-02-10 |
| 1689046500 | Christine Chanmyaethu Tun | Physician Assistant | 559 Vincent St, Attn: 21 Mods/sgof - Family Health, Peterson Afb, CO 80914-1540 | 2015-10-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356897250 | Kym Littlefield Whitaker | Nurse Practitioner | 110 Ent Avenue, Peterson Afb, CA 80914 | 2016-08-30 |
| 1114322583 | Jessica Charmaine Johnson | Social Worker | 559 Vincent St, Bldg 959, Attn: 21 Omrs/sgow, Peterson Afb, CO 80914 | 2014-10-28 |
| 1306916267 | John Frank Drozd | Psychologist | 21st Medical Group, 559 Vincent Street, Peterson Afb, CO 80914 | 2006-11-08 |
| 1801858865 | Moshe Mark Douglas Wexler | Clinical Neuropsychologist | 110 W. Ent Ave. Bldg 725, 21 Mdos/sgoh, Pafb, CO 80914 | 2006-04-05 |
| 1215902002 | William J Dickson | Dentist | Peterson Afb, Bld 950, Colorado Springs, CO 80914 | 2006-02-23 |
| 1740889773 | Brandon Dean Estes | Dental Hygienist | 1055 Stewart Ave, Bldg 2018, Apo, AA 80914 | 2020-10-21 |
| 1225458789 | Brianna Mcmurray | Family Medicine | 559 Vincent St Bldg 959, Colorado Springs, CO 80914 | 2014-04-23 |
| 1720406796 | Beth D Achterhoff | Physical Therapist | 559 Vincent St Bldg 959, Peterson Afb, CO 80914 | 2014-04-07 |
| 1275712895 | Monica Ibarra | Counselor | 559 Vincent St., Attn: 21 Mdos/sgow - Family Advocacy, Peterson Afb, CO 80914 | 2007-10-31 |
| 1912258591 | Ruth Angela Monsanto-williams | Nurse Practitioner | 110 West Ent Ave, Peterson Afb, 21st Medical Group, Colorado Springs, CO 80914-1540 | 2012-09-24 |
| Find all providers in zip 80914 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467895318 | Evans Army Community Hospital | Clinic/Center | Bldg 2361 Titus Blvd, Ft Carson, CO 80913 | 2013-04-10 |
| 1912340894 | Evans Army Community Hospital | Clinic/Center | Building 1226 Felkins St, Ft Carson, CO 80913 | 2013-04-10 |
| 1558704429 | Evans Army Community Hospital | Clinic/Center | Building 1657 Barkley Ave, Ft Carson, CO 80913 | 2013-04-10 |
| 1376986240 | Evans Army Community Hospital | Clinic/Center | Building 9481 Wilderness Rd, Ft Carson, CO 80913 | 2013-04-10 |
| 1770826968 | Evans Army Community Hospital | Clinic/Center | Bldg 2649 Specker Ave, Ft Carson, CO 80913 | 2013-04-05 |
| 1447565528 | Evans Army Community Hospital | Clinic/Center | 7503 Cochrane Cir, Usadc-2, Ft Carson, CO 80913-4603 | 2010-08-12 |
| 1124221619 | Evans Army Community Hospital | Clinic/Center | 2356 Quinn Street, Fort Carson, CO 80913 | 2007-06-11 |
| 1215130703 | Evans Army Community Hospital | Clinic/Center | 1227 Felkins Street, Fort Carson, CO 80913 | 2007-06-11 |
| 1134322993 | Evans Army Community Hospital | Clinic/Center | 2280 Hogan St, Fort Carson, CO 80913-4408 | 2007-06-08 |
| 1336355056 | Evans Army Community Hospital | Clinic/Center | 6911 Titus Blvd, Bldg 2353 Warrior Family Medicine Clinic, Fort Carson, CO 80913-4429 | 2007-05-16 |
| Find all providers with the same taxonomy | ||||
| City | PETERSON AFB |
| Zip Code | 80914 |
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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.