GRACE ALFONSI

NPI 1174533616 · Family Medicine · Anthem

Provider Status Assessment

Needs Review

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

Confidence: High

Evidence: 5652 items from 16 sources

Signals: 7 supporting · 0 opposing

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

Data Source Signals

✗

NPPES

DENVER, 80204

Freshness: Stale (last updated 2021-03-18)

1,815 days since update

✓

Network Status

Listed with 8 carriers

anthem_co — in_network (commercial)
uhc_services_co — in_network (commercial)
uhc_colorado_co — in_network (commercial)
uhc_insurance_co — in_network (commercial)
uhc_umr_co — in_network (commercial)
uhc_surest_co — in_network (commercial)
kpic_co — in_network (commercial)
kaiser_co — in_network (commercial)

✓

DORA License

Active

✗

Medicare

Enrolled but no billing activity

✓

Care Compare

Address matches NPPES

DENVER, 80204

✓

PECOS Enrollment

System Reasoning

Claim Under Evaluation

Provider is actively practicing and appropriately listed in carrier networks

Evidence Evaluated

Medicare Billing: Enrolled in Medicare but no recent billing data

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

Colorado DORA License: License status: Active

PECOS Enrollment: Medicare enrollment confirmed

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

Carrier Networks: Listed in 8 carrier networks

CMS Care Compare: Found in Care Compare with 1 location

FHIR Directory: Active endpoint in carrier FHIR directory

Trust Evaluation

identity:0.75Strong

licensure:0.90Strong

activity:

Dimension Scores

Composite0.72

Identity0.75 — Moderate

Active NPI with specialty classification

Licensure0.90 — Strong

Active Colorado DORA license confirmed

Activity0.45 — Weak

No Medicare billing · No electronic endpoint

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

8 networks across 3 carriers

Anthem(1 network)

1 DOI 6C-3

Anthem Blue Cross Blue ShieldDOI 6C-3

View carrier →

UnitedHealthcare(5 networks)

1 DOI 6C-34 Federal TiC

UnitedHealthcare ServicesFederal TiC

View carrier →

UnitedHealthcare of ColoradoDOI 6C-3

View carrier →

UnitedHealthcare InsuranceFederal TiC

View carrier →

Related Investigations

All providers in Anthem Blue Cross Blue Shield networkView →All Family Medicine providers statewideView →All providers in DENVER 80204View →All providers classified as Needs ReviewView →

Known Addresses

NPPESDENVER, 80204

Care CompareDENVER, 80204

Evidence

5652 items across 22 assertions from 16 sources

Connected Records

Colorado License

Revoked

DORA

FHIR Directory Status

Not found in directory

FHIR: uhc

Practice Address

DENVER, 80204

cms_care_compare, NPPES

Carrier Network Listing

Listed in 8 carrier networks

TiC: Anthem Blue Cross Blue Shield, TiC: UnitedHealthcare Services, TiC: UnitedHealthcare Insurance, TiC: UnitedHealthcare (UMR), TiC: UnitedHealthcare Colorado, TiC: UnitedHealthcare (Surest), TiC: Kaiser Permanente Insurance Company, TiC: Kaiser Permanente

Electronic Endpoint

Record found

nppes_endpoint

Order/Referring Eligibility

Record found

cms_order_refer

Medicare Enrollment

Enrolled

PECOS

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 Shield5589 records ·weight 0.80 · Latest: Mar 14, 2026

Colorado License StatusTrust: 0.95

↓DORAweight 0.98 · Mar 13, 2026

Matched via: license_number

Colorado License StatusTrust: 0.95

↓DORA4 records ·weight 0.98 · Latest: Mar 6, 2026

Matched via: license_number

Colorado License StatusTrust: 0.95

↓DORAweight 0.98 · Mar 13, 2026

Matched via: license_number

Colorado License StatusTrust: 0.95

↓DORAweight 0.98 · Mar 13, 2026

Timeline

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

Mar 13, 2026DORA license check: Revoked

Mar 13, 2026DORA license check: Active

Mar 13, 2026DORA license check: Expired

Mar 13, 2026FHIR directory lookup: not found

Mar 12, 2026Carrier listing: UnitedHealthcare Services

Mar 12, 2026Carrier listing: UnitedHealthcare Insurance

Mar 12, 2026Electronic Endpoint: record found

Mar 12, 2026Carrier listing: UnitedHealthcare (UMR)

Mar 12, 2026Carrier listing: UnitedHealthcare Colorado

Mar 11, 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.

Order/Referring eligible: Yes

reachability:0.60Moderate

System Determination

Needs Review

Composite score: 0.720

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

UnitedHealthcare UMR

UnitedHealthcare SurestFederal TiC

View carrier →

Kaiser Permanente(2 networks)

2 DOI 6C-3

Kaiser Permanente Insurance CoDOI 6C-3

View carrier →

Kaiser PermanenteDOI 6C-3

View carrier →

Evidence

5652 items across 22 assertions from 16 sources

Connected Records

Colorado License

Revoked

DORA

FHIR Directory Status

Not found in directory

FHIR: uhc

Practice Address

DENVER, 80204

cms_care_compare, NPPES

Carrier Network Listing

Listed in 8 carrier networks

Electronic Endpoint

Record found

nppes_endpoint

Order/Referring Eligibility

Record found

cms_order_refer

Medicare Enrollment

Enrolled

PECOS

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 Shield5589 records ·weight 0.80 · Latest: Mar 14, 2026

Colorado License StatusTrust: 0.95

↓DORAweight 0.98 · Mar 13, 2026

Matched via: license_number

Colorado License StatusTrust: 0.95

↓DORA4 records ·weight 0.98 · Latest: Mar 6, 2026

Matched via: license_number

Colorado License StatusTrust: 0.95

↓DORAweight 0.98 · Mar 13, 2026

Matched via: license_number

Colorado License StatusTrust: 0.95

↓DORAweight 0.98 · Mar 13, 2026

Timeline

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

Mar 13, 2026DORA license check: Revoked

Mar 13, 2026DORA license check: Active

Mar 13, 2026DORA license check: Expired

Mar 13, 2026FHIR directory lookup: not found

Mar 12, 2026Carrier listing: UnitedHealthcare Services

Mar 12, 2026Carrier listing: UnitedHealthcare Insurance

Mar 12, 2026Electronic Endpoint: record found

Mar 12, 2026Carrier listing: UnitedHealthcare (UMR)

Mar 12, 2026Carrier listing: UnitedHealthcare Colorado

Mar 11, 2026

Matched via: license_number

Colorado License StatusTrust: 0.95

↓DORAweight 0.98 · Mar 13, 2026

Matched via: license_number

Colorado License StatusTrust: 0.95

↓DORA9 records ·weight 0.98 · Latest: Mar 13, 2026

Matched via: license_number

FHIR Directory StatusTrust: 0.90

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

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare Services7 records ·weight 0.80 · Latest: Mar 12, 2026

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare Insurance4 records ·weight 0.80 · Latest: Mar 12, 2026

Electronic EndpointTrust: 0.85

↓nppes_endpointweight 0.85 · Mar 12, 2026

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare (UMR)17 records ·weight 0.80 · Latest: Mar 12, 2026

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare Colorado2 records ·weight 0.80 · Latest: Mar 12, 2026

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare (Surest)3 records ·weight 0.80 · Latest: Mar 11, 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: Kaiser Permanente Insurance Companyweight 0.80 · Mar 11, 2026

NPI Registration StatusTrust: 0.90

↓NPPES2 records ·weight 0.40 · Latest: Mar 7, 2026

Practice LocationTrust: 0.85

↓cms_care_compareweight 0.80 · Mar 6, 2026

↓NPPESweight 0.85 · Mar 5, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Kaiser Permanenteweight 0.80 · Mar 5, 2026

Provider SpecialtyTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

entity_typeTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

Carrier listing: UnitedHealthcare (Surest)

Mar 11, 2026Order/Referring Eligibility: record found

Mar 11, 2026Medicare enrollment: Approved

Mar 11, 2026Carrier listing: Kaiser Permanente Insurance Company

Mar 7, 2026NPPES record: active

Mar 6, 2026Practice address: DENVER, 80204

Mar 5, 2026Carrier listing: Kaiser Permanente

Mar 5, 2026Practice address: DENVER, 80204

Mar 5, 2026Provider Specialty: record found

Mar 5, 2026entity_type: record found