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NPI 1619282738 · Nurse Practitioner · Anthem

Provider Status Assessment

Needs Review

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

Confidence: High

Evidence: 166 items from 15 sources

Signals: 6 supporting · 1 opposing · 1 missing

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

Data Source Signals

✓

NPPES

DENVER, 80205

Freshness: Unknown

✓

Network Status

Listed with 10 carriers

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

✗

DORA License

Expired

✓

Medicare

57 services

11 beneficiaries

$870.18 total payment

Specialty: Nurse Practitioner

—

Care Compare

No Care Compare data

✓

PECOS Enrollment

System Reasoning

Claim Under Evaluation

Provider is actively practicing and appropriately listed in carrier networks

Evidence Evaluated

Colorado DORA License: License status: Expired

NPPES Registry: Active NPI, registered in DENVER

Medicare Billing: 57 services, 11 beneficiaries

PECOS Enrollment: Medicare enrollment confirmed

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

Carrier Networks: Listed in 10 carrier networks

FHIR Directory: Active endpoint in carrier FHIR directory

CMS Care Compare: Not found in CMS Care Compare

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

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 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 Nurse Practitioner providers statewideView →All providers in DENVER 80205View →All providers classified as Needs ReviewView →

Known Addresses

NPPESDENVER, 80205

Evidence

166 items across 23 assertions from 15 sources

Connected Records

Colorado License

Expired

DORA

Practice Address

DENVER, 80205

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

NPI Registration

Status: active

NPPES Deactivation

Order/Referring Eligibility

Record found

cms_order_refer

Medicare Enrollment

Enrolled

PECOS

Medicare Billing

57 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 Shield101 records ·weight 0.80 · Latest: Mar 13, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shield2 records ·weight 0.80 · Latest: Mar 13, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shieldweight 0.80 · Mar 13, 2026

Colorado License StatusTrust: 0.95

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

Matched via: primary

Colorado License StatusTrust: 0.95

↓DORA

Timeline

Mar 13, 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, 2026Electronic Endpoint: record found

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, 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.

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 →

Kaiser Permanente(2 networks)

2 DOI 6C-3

Kaiser Permanente Insurance CoDOI 6C-3

View carrier →

Kaiser PermanenteDOI 6C-3

View carrier →

Evidence

166 items across 23 assertions from 15 sources

Connected Records

Colorado License

Expired

DORA

Practice Address

DENVER, 80205

NPPES

Carrier Network Listing

Listed in 8 carrier networks

Electronic Endpoint

Record found

nppes_endpoint

NPI Registration

Status: active

NPPES Deactivation

Order/Referring Eligibility

Record found

cms_order_refer

Medicare Enrollment

Enrolled

PECOS

Medicare Billing

57 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 Shield101 records ·weight 0.80 · Latest: Mar 13, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shield2 records ·weight 0.80 · Latest: Mar 13, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shieldweight 0.80 · Mar 13, 2026

Colorado License StatusTrust: 0.95

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

Matched via: primary

Colorado License StatusTrust: 0.95

↓DORA

Timeline

Mar 13, 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, 2026Electronic Endpoint: record found

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, 2026Order/Referring Eligibility: record found

Mar 11, 2026

weight 0.60 · Latest: Mar 13, 2026

Matched via: primary

Colorado License StatusTrust: 0.95

↓DORA3 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

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

Matched via: primary

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare Services8 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

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

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

Medicare Billing ActivityTrust: 0.90

↓cms_medicareweight 0.70 · Mar 6, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Kaiser Permanenteweight 0.80 · Mar 5, 2026

Provider SpecialtyTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

Practice LocationTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

entity_typeTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

Medicare enrollment: Approved

Mar 11, 2026Carrier listing: Kaiser Permanente Insurance Company

Mar 6, 2026Medicare billing: 57 services

Mar 5, 2026Carrier listing: Kaiser Permanente

Mar 5, 2026Provider Specialty: record found

Mar 5, 2026Practice address: DENVER, 80205

Mar 5, 2026entity_type: record found