JAMES COUGHLAN

NPI 1699701458 · Physical Therapist in Private Practice · Anthem

Provider Status Assessment

Verified Active

Strong multi-source corroboration of active practice across 9 carrier networks with confirmed Colorado DORA license.

Confidence: High

Evidence: 5399 items from 15 sources

Signals: 7 supporting · 0 opposing

Resolution: All evidence sources corroborate active practice. 7 supporting signals with no contradictions across 8 evaluated sources.

Data Source Signals

✓

NPPES

WHEAT RIDGE, 80033

Freshness: Unknown

✓

Network Status

Listed with 9 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)
cigna_co — in_network (commercial)
kpic_co — in_network (commercial)
kaiser_co — in_network (commercial)

✓

DORA License

Active

—

Medicare

Non-Medicare specialty

22 beneficiaries

$9,951.84 total payment

Specialty: Physical Therapist in Private Practice

✗

Care Compare

Address mismatch with NPPES

BROOMFIELD, 80021
FIRESTONE, 80504
WHEAT RIDGE, 80033

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 WHEAT RIDGE

Colorado DORA License: License status: Active

Medicare Billing: 430 services, 22 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 3 locations

Trust Evaluation

identity:0.75Strong

licensure:0.90Strong

activity:

Dimension Scores

Composite0.86

Identity0.75 — Moderate

Active NPI with specialty classification

Licensure0.90 — Strong

Active Colorado DORA license confirmed

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 “verified active”?

Strong multi-source corroboration of active practice. All dimensions above 0.55 with evidence depth ≥ 5. Active license confirmed.

Carrier Network Listings

9 networks across 4 carriers

Strong network presence across 9 carrier networks with corroborating federal activity signals.

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

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UnitedHealthcare of ColoradoDOI 6C-3

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UnitedHealthcare InsuranceFederal TiC

View carrier →

Related Investigations

All providers in Anthem Blue Cross Blue Shield networkView →All Physical Therapist in Private Practice providers statewideView →All providers in WHEAT RIDGE 80033View →All providers classified as Verified ActiveView →

Known Addresses

NPPESWHEAT RIDGE, 80033

Care CompareBROOMFIELD, 80021

Care CompareFIRESTONE, 80504

Care CompareWHEAT RIDGE, 80033

Evidence

5399 items across 18 assertions from 15 sources

Connected Records

Practice Address

WHEAT RIDGE, 80033

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: Cigna, TiC: Kaiser Permanente Insurance Company, TiC: Kaiser Permanente

Colorado License

Active

DORA

NPI Registration

Status: active

NPPES Deactivation

Medicare Enrollment

Enrolled

PECOS

Medicare Billing

430 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 Shield5348 records ·weight 0.80 · Latest: Mar 14, 2026

Colorado License StatusTrust: 0.95

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

Matched via: primary

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare Services6 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

Timeline

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

Mar 13, 2026DORA license check: Active

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: Cigna

Mar 11, 2026Medicare enrollment: Approved

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

reachability:0.60Moderate

System Determination

Verified Active

Composite score: 0.858

Strong multi-source corroboration of active practice across 9 carrier networks with confirmed Colorado DORA license.

UnitedHealthcare UMRFederal TiC

View carrier →

UnitedHealthcare SurestFederal TiC

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 PermanenteDOI 6C-3

View carrier →

Evidence

5399 items across 18 assertions from 15 sources

Connected Records

Practice Address

WHEAT RIDGE, 80033

cms_care_compare, NPPES

Carrier Network Listing

Listed in 9 carrier networks

Colorado License

Active

DORA

NPI Registration

Status: active

NPPES Deactivation

Medicare Enrollment

Enrolled

PECOS

Medicare Billing

430 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 Shield5348 records ·weight 0.80 · Latest: Mar 14, 2026

Colorado License StatusTrust: 0.95

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

Matched via: primary

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare Services6 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

Timeline

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

Mar 13, 2026DORA license check: Active

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: Cigna

Mar 11, 2026Medicare enrollment: Approved

Mar 11, 2026

weight 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: Cigna5 records ·weight 0.80 · Latest: 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: 0.85

↓cms_care_compareweight 0.80 · Mar 6, 2026

↓NPPESweight 0.85 · Mar 5, 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

Carrier Network ListingTrust: 0.80

↓TiC: Kaiser Permanenteweight 0.80 · Mar 5, 2026

entity_typeTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

Provider SpecialtyTrust: 0.85

↓NPPESweight 0.85 · Mar 5, 2026

Carrier listing: Kaiser Permanente Insurance Company

Mar 6, 2026Practice address: WHEAT RIDGE, 80033

Mar 6, 2026Practice address: BROOMFIELD, 80021

Mar 6, 2026Practice address: FIRESTONE, 80504

Mar 6, 2026Medicare billing: 430 services

Mar 5, 2026Carrier listing: Kaiser Permanente

Mar 5, 2026entity_type: record found

Mar 5, 2026Practice address: WHEAT RIDGE, 80033

Mar 5, 2026Provider Specialty: record found