JOSE PACHECO

NPI 1417945759 · Cardiology · Anthem

Provider Status Assessment

Needs Review

Carrier listings present but Colorado DORA license appears expired or revoked.

Confidence: High

Evidence: 9431 items from 16 sources

Signals: 6 supporting · 1 opposing

Resolution: Carrier listings present but Colorado DORA license appears expired or revoked. Licensure concern outweighs network presence.

Data Source Signals

✓

NPPES

THORNTON, 80229

Freshness: Unknown

✓

Network Status

Listed with 9 carriers

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

✗

DORA License

Expired

✓

Medicare

135 services

74 beneficiaries

$6,554.02 total payment

Specialty: Cardiology

✗

Care Compare

Address mismatch with NPPES

CENTENNIAL, 80112

✓

System Reasoning

Claim Under Evaluation

Provider is actively practicing and appropriately listed in carrier networks

Evidence Evaluated

Colorado DORA License: License status: Expired

FHIR Directory: No active FHIR endpoint despite carrier listings

NPPES Registry: Active NPI, registered in THORNTON

Medicare Billing: 135 services, 74 beneficiaries

PECOS Enrollment: Medicare enrollment confirmed

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

Carrier Networks: Listed in 9 carrier networks

CMS Care Compare: Found in Care Compare with 1 location

Trust Evaluation

identity:0.75Strong

licensure:0.20Critical

activity:1.00

Dimension Scores

Composite0.72

Identity0.75 — Moderate

Active NPI with specialty classification

Licensure0.20 — Critical

DORA license expired or revoked

Activity1.00 — 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

9 networks across 3 carriers

Anthem(1 network)

1 DOI 6C-3

Anthem Blue Cross Blue ShieldDOI 6C-3

View carrier →

UnitedHealthcare(6 networks)

2 DOI 6C-34 Federal TiC

UnitedHealthcare of ColoradoDOI 6C-3

View carrier →

UnitedHealthcare InsuranceFederal TiC

View carrier →

UnitedHealthcare ServicesFederal TiC

View carrier →

Related Investigations

All providers in Anthem Blue Cross Blue Shield networkView →All Cardiology providers statewideView →All providers in THORNTON 80229View →All providers classified as Needs ReviewView →

Known Addresses

NPPESTHORNTON, 80229

Care CompareCENTENNIAL, 80112

Evidence

9431 items across 20 assertions from 16 sources

Connected Records

Colorado License

Expired

DORA

Practice Address

CENTENNIAL, 80112

cms_care_compare, NPPES

Carrier Network Listing

Listed in 9 carrier networks

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

NPI Registration

Status: active

NPPES Deactivation

Order/Referring Eligibility

Record found

cms_order_refer

Medicare Enrollment

Enrolled

PECOS

Medicare Billing

135 services

cms_medicare

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 Shield9376 records ·weight 0.80 · Latest: Mar 14, 2026

Colorado License StatusTrust: 0.95

↓DORA3 records ·weight 0.80 · Latest: Mar 13, 2026

Matched via: primary

Colorado License StatusTrust: 0.95

↓DORA2 records ·weight 0.80 · Latest: Mar 13, 2026

Matched via: primary

Colorado License StatusTrust: 0.95

↓DORA2 records ·weight 0.80 · Latest: Mar 13, 2026

Matched via: primary

Carrier Network ListingTrust: 0.80

Timeline

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

Mar 13, 2026DORA license check: Expired

Mar 12, 2026Carrier listing: UnitedHealthcare Services

Mar 12, 2026Carrier listing: UnitedHealthcare Insurance

Mar 12, 2026NPPES record: active

Mar 12, 2026Carrier listing: UnitedHealthcare (UMR)

Mar 12, 2026Carrier listing: UnitedHealthcare Colorado

Mar 11, 2026Carrier listing: UnitedHealthcare (Surest)

Mar 11, 2026Carrier listing: UnitedHealthcare (Rocky Mountain HMO)

Mar 11, 2026Order/Referring Eligibility: record found

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.

PECOS Enrollment

Medicare enrolled

Order/Referring eligible: Yes

reachability:0.60Moderate

System Determination

Needs Review

Composite score: 0.718

Carrier listings present but Colorado DORA license appears expired or revoked.

UnitedHealthcare UMR

UnitedHealthcare SurestFederal TiC

View carrier →

UnitedHealthcare Rocky Mountain HMODOI 6C-3

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

9431 items across 20 assertions from 16 sources

Connected Records

Colorado License

Expired

DORA

Practice Address

CENTENNIAL, 80112

cms_care_compare, NPPES

Carrier Network Listing

Listed in 9 carrier networks

NPI Registration

Status: active

NPPES Deactivation

Order/Referring Eligibility

Record found

cms_order_refer

Medicare Enrollment

Enrolled

PECOS

Medicare Billing

135 services

cms_medicare

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 Shield9376 records ·weight 0.80 · Latest: Mar 14, 2026

Colorado License StatusTrust: 0.95

↓DORA3 records ·weight 0.80 · Latest: Mar 13, 2026

Matched via: primary

Colorado License StatusTrust: 0.95

↓DORA2 records ·weight 0.80 · Latest: Mar 13, 2026

Matched via: primary

Colorado License StatusTrust: 0.95

↓DORA2 records ·weight 0.80 · Latest: Mar 13, 2026

Matched via: primary

Carrier Network ListingTrust: 0.80

Timeline

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

Mar 13, 2026DORA license check: Expired

Mar 12, 2026Carrier listing: UnitedHealthcare Services

Mar 12, 2026Carrier listing: UnitedHealthcare Insurance

Mar 12, 2026NPPES record: active

Mar 12, 2026Carrier listing: UnitedHealthcare (UMR)

Mar 12, 2026Carrier listing: UnitedHealthcare Colorado

Mar 11, 2026Carrier listing: UnitedHealthcare (Surest)

Mar 11, 2026Carrier listing: UnitedHealthcare (Rocky Mountain HMO)

Mar 11, 2026Order/Referring Eligibility: record found

Mar 11, 2026

↓TiC: UnitedHealthcare Services9 records ·weight 0.80 · Latest: Mar 12, 2026

Carrier Network ListingTrust: 0.80

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

NPI Registration StatusTrust: 0.90

↓NPPES Deactivationweight 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

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare (Rocky Mountain HMO)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

Practice LocationTrust: 0.80

↓cms_care_compareweight 0.80 · Mar 6, 2026

Medicare Billing ActivityTrust: 0.90

↓cms_medicareweight 0.85 · Mar 6, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Kaiser Permanenteweight 0.80 · Mar 5, 2026

Practice LocationTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

entity_typeTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

Provider SpecialtyTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

Medicare enrollment: Approved

Mar 11, 2026Carrier listing: Kaiser Permanente Insurance Company

Mar 6, 2026Practice address: CENTENNIAL, 80112

Mar 6, 2026Medicare billing: 135 services

Mar 5, 2026Carrier listing: Kaiser Permanente

Mar 5, 2026Practice address: THORNTON, 80229

Mar 5, 2026entity_type: record found

Mar 5, 2026Provider Specialty: record found