NPI 1104069376 · Family Practice · Anthem
Strong multi-source corroboration of active practice across 3 carrier networks with confirmed Colorado DORA license.
NPPES
CASTLE ROCK, 80104
Freshness: Unknown
Network Status
Listed with 4 carriers
DORA License
Active
Medicare
32 services
14 beneficiaries
$2,649.46 total payment
Specialty: Family Practice
Care Compare
Address mismatch with NPPES
PECOS Enrollment
Medicare enrolled
Order/Referring eligible: Yes
Active NPI with specialty classification
Active Colorado DORA license confirmed
Active Medicare billing confirmed
Single address source (NPPES)
Limited carrier network presence
3 networks across 2 carriers
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.