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NPI 1003143850 · Nurse Practitioner · Anthem

Provider Status Assessment

Needs Review

Evidence across dimensions is contradictory — supporting and opposing signals are present.

Confidence: High

Evidence: 5347 items from 13 sources

Signals: 7 supporting · 0 opposing

Resolution: Mixed signals across dimensions prevent confident classification. Manual review recommended.

Data Source Signals

✗

NPPES

LAKEWOOD, 80226

Freshness: Stale (last updated 2017-12-02)

3,016 days since update

✓

Network Status

Listed with 6 carriers

anthem_co — in_network (commercial)
anthem_co — in_network (commercial)
cigna_co — in_network (commercial)
kpic_co — in_network (commercial)
aetna_co — in_network (commercial)
kaiser_co — in_network (commercial)

✓

DORA License

Active

✓

Medicare

129 services

73 beneficiaries

$6,798.59 total payment

Specialty: Nurse Practitioner

✗

Care Compare

Address mismatch with NPPES

ARVADA, 80002
AURORA, 80013
BRIGHTON, 80601
BROOMFIELD, 80020
GOLDEN, 80401
GREELEY, 80634
THORNTON, 80229

System Reasoning

Claim Under Evaluation

Provider is actively practicing and appropriately listed in carrier networks

Evidence Evaluated

FHIR Directory: No active FHIR endpoint despite carrier listings

NPPES Registry: Active NPI, registered in LAKEWOOD (record aging)

Colorado DORA License: License status: Active

Medicare Billing: 129 services, 73 beneficiaries

PECOS Enrollment: Medicare enrollment confirmed

Federal Exclusion Check: No federal exclusions found (OIG LEIE, SAM.gov)

Carrier Networks: Listed in 6 carrier networks

CMS Care Compare: Found in Care Compare with 7 locations

Trust Evaluation

identity:0.75Strong

licensure:0.90Strong

activity:

Dimension Scores

Composite0.83

Identity0.75 — Moderate

Active NPI with specialty classification

Licensure0.90 — Strong

Active Colorado DORA license confirmed

Activity0.90 — Strong

Active Medicare billing confirmed

Reachability0.60 — Moderate

Single address source (NPPES)

Network1.00 — Strong

Listed in multiple carrier networks

Why is this provider classified as “needs review”?

Evidence across dimensions is contradictory or specific concerns exist (unverified license, FHIR directory contradiction). Manual review recommended.

Carrier Network Listings

5 networks across 4 carriers

Anthem(1 network)

1 DOI 6C-3

Anthem Blue Cross Blue ShieldDOI 6C-3

View carrier →

Cigna(1 network)

1 DOI 6C-3

CignaDOI 6C-3

View carrier →

Kaiser Permanente(2 networks)

2 DOI 6C-3

Kaiser Permanente Insurance CoDOI 6C-3

View carrier →

Kaiser Permanente

Related Investigations

All providers in Anthem Blue Cross Blue Shield networkView →All Nurse Practitioner providers statewideView →All providers in LAKEWOOD 80226View →All providers classified as Needs ReviewView →

Known Addresses

NPPESLAKEWOOD, 80226

Care CompareARVADA, 80002

Care CompareAURORA, 80013

Care CompareBRIGHTON, 80601

Care CompareBROOMFIELD, 80020

Care CompareGOLDEN, 80401

Care CompareGREELEY, 80634

Care CompareTHORNTON, 80229

Evidence

5347 items across 26 assertions from 13 sources

Connected Records

Colorado License

Voluntary Surrender

DORA

FHIR Directory Status

Not found in directory

FHIR: uhc

Practice Address

BRIGHTON, 80601

cms_care_compare, NPPES

Carrier Network Listing

Listed in 5 carrier networks

TiC: Anthem Blue Cross Blue Shield, TiC: Cigna, TiC: Kaiser Permanente Insurance Company, TiC: Aetna, TiC: Kaiser Permanente

Order/Referring Eligibility

Record found

cms_order_refer

Medicare Enrollment

Enrolled

PECOS

Medicare Billing

129 services

cms_medicare

NPI Registration

Status: active

NPPES

entity_type

Record found

NPPES

Federal Exclusion Check

No exclusion found

OIG LEIE + SAM.gov

Evidence Lineage

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shield5295 records ·weight 0.80 · Latest: Mar 14, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shield4 records ·weight 0.80 · Latest: Mar 14, 2026

Colorado License StatusTrust: 0.95

↓DORA9 records ·weight 0.60 · Latest: Mar 13, 2026

Matched via: primary

Colorado License StatusTrust: 0.95

↓DORA4 records ·weight 0.60 · Latest: Mar 6, 2026

Matched via: primary

Colorado License StatusTrust: 0.95

Timeline

Mar 14, 2026Carrier listing: Anthem Blue Cross Blue Shield

Mar 13, 2026DORA license check: Voluntary Surrender

Mar 13, 2026DORA license check: Active

Mar 13, 2026FHIR directory lookup: not found

Mar 11, 2026Order/Referring Eligibility: record found

Mar 11, 2026Medicare enrollment: Approved

Mar 11, 2026Carrier listing: Cigna

Mar 11, 2026Carrier listing: Kaiser Permanente Insurance Company

Mar 11, 2026Carrier listing: Aetna

Mar 6, 2026Practice address: BRIGHTON, 80601

Mar 6, 2026

Evidence

Loading evidence lineage...

Disclaimer: This analysis uses publicly available federal and state data sources. It does not constitute a determination of provider status or network participation. Contact the provider or health plan directly to verify current status.

PECOS Enrollment

Medicare enrolled

Order/Referring eligible: Yes

reachability:0.60Moderate

System Determination

Needs Review

Composite score: 0.833

Evidence across dimensions is contradictory — supporting and opposing signals are present.

Aetna(1 network)

1 DOI 6C-3

AetnaDOI 6C-3

View carrier →

Evidence

5347 items across 26 assertions from 13 sources

Connected Records

Colorado License

Voluntary Surrender

DORA

FHIR Directory Status

Not found in directory

FHIR: uhc

Practice Address

BRIGHTON, 80601

cms_care_compare, NPPES

Carrier Network Listing

Listed in 5 carrier networks

TiC: Anthem Blue Cross Blue Shield, TiC: Cigna, TiC: Kaiser Permanente Insurance Company, TiC: Aetna, TiC: Kaiser Permanente

Order/Referring Eligibility

Record found

cms_order_refer

Medicare Enrollment

Enrolled

PECOS

Medicare Billing

129 services

cms_medicare

NPI Registration

Status: active

NPPES

entity_type

Record found

NPPES

Federal Exclusion Check

No exclusion found

OIG LEIE + SAM.gov

Evidence Lineage

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shield5295 records ·weight 0.80 · Latest: Mar 14, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shield4 records ·weight 0.80 · Latest: Mar 14, 2026

Colorado License StatusTrust: 0.95

↓DORA9 records ·weight 0.60 · Latest: Mar 13, 2026

Matched via: primary

Colorado License StatusTrust: 0.95

↓DORA4 records ·weight 0.60 · Latest: Mar 6, 2026

Matched via: primary

Colorado License StatusTrust: 0.95

Timeline

Mar 14, 2026Carrier listing: Anthem Blue Cross Blue Shield

Mar 13, 2026DORA license check: Voluntary Surrender

Mar 13, 2026DORA license check: Active

Mar 13, 2026FHIR directory lookup: not found

Mar 11, 2026Order/Referring Eligibility: record found

Mar 11, 2026Medicare enrollment: Approved

Mar 11, 2026Carrier listing: Cigna

Mar 11, 2026Carrier listing: Kaiser Permanente Insurance Company

Mar 11, 2026Carrier listing: Aetna

Mar 6, 2026Practice address: BRIGHTON, 80601

Mar 6, 2026

weight 0.98 · Latest: Mar 6, 2026

Matched via: license_number

Colorado License StatusTrust: 0.95

↓DORA4 records ·weight 0.60 · Latest: Mar 6, 2026

Matched via: primary

Colorado License StatusTrust: 0.95

↓DORA3 records ·weight 0.60 · Latest: Mar 13, 2026

Matched via: primary

FHIR Directory StatusTrust: 0.90

↓FHIR: uhc2 records ·weight 0.90 · Latest: Mar 13, 2026

Order/Referring EligibilityTrust: 0.95

↓cms_order_referweight 0.95 · Mar 11, 2026

Medicare EnrollmentTrust: 0.95

↓PECOSweight 0.95 · Mar 11, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Cigna2 records ·weight 0.80 · Latest: Mar 11, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Kaiser Permanente Insurance Company2 records ·weight 0.80 · Latest: Mar 11, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Aetna3 records ·weight 0.80 · Latest: Mar 11, 2026

Practice LocationTrust: 0.80

↓cms_care_compareweight 0.80 · Mar 6, 2026

Practice LocationTrust: 0.80

↓cms_care_compareweight 0.80 · Mar 6, 2026

Practice LocationTrust: 0.80

↓cms_care_compareweight 0.80 · Mar 6, 2026

Practice LocationTrust: 0.80

↓cms_care_compareweight 0.80 · Mar 6, 2026

Practice LocationTrust: 0.80

↓cms_care_compareweight 0.80 · Mar 6, 2026

Practice LocationTrust: 0.80

↓cms_care_compareweight 0.80 · Mar 6, 2026

Practice LocationTrust: 0.80

↓cms_care_compareweight 0.80 · Mar 6, 2026

Medicare Billing ActivityTrust: 0.90

↓cms_medicareweight 0.85 · Mar 6, 2026

NPI Registration StatusTrust: 0.90

↓NPPESweight 0.25 · Mar 6, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Kaiser Permanenteweight 0.80 · Mar 5, 2026

entity_typeTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

Practice LocationTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

Provider SpecialtyTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

Practice address: GREELEY, 80634

Mar 6, 2026Practice address: GOLDEN, 80401

Mar 6, 2026Practice address: THORNTON, 80229

Mar 6, 2026Practice address: BROOMFIELD, 80020

Mar 6, 2026Practice address: ARVADA, 80002

Mar 6, 2026Practice address: AURORA, 80013

Mar 6, 2026Medicare billing: 129 services

Mar 6, 2026NPPES record: active

Mar 5, 2026Carrier listing: Kaiser Permanente

Mar 5, 2026entity_type: record found

Showing 20 of 22 evidence events.