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BOULDER PLASTIC SURGERY PROF LLC
NPI 1033705926
Specialist in Boulder, CO

Active since December 15, 2020CLIA 06D2197453 · Waiver
4747 ARAPAHOE AVE, BOULDER, CO 80303(720) 854-7000 Get Directions Write a Review

NPPES record last updated: December 15, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Boulder Plastic Surgery Prof Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BOULDER PLASTIC SURGERY PROF LLC (NPI 1033705926) is a healthcare organization registered as a specialist in Boulder, Colorado and active in the NPI registry since December 2020. The organization holds a CLIA Waiver certificate valid through October 25, 2026 and lists Pam Garcia, Office Contact, as its authorized official.

NPPES Registry Identity

NPI1033705926
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameBOULDER PLASTIC SURGERY PROF LLC
Location Address4747 ARAPAHOE AVEBoulder, CO 80303-1131
Mailing AddressPo Box 7643Loveland, CO 80537-0643 · (970) 663-2742
Phone(720) 854-7000
Organization SubpartNo
Authorized OfficialPam GarciaOffice Contact · (303) 443-2277
Enumeration DateDecember 15, 2020
NPPES CertifiedDecember 15, 2020
✔ NPI 1033705926 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
4747 ARAPAHOE AVE, Boulder, CO 80303
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Boulder Plastic Surgery Prof Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateColoradoEnrollment IDO20040302000408Non-DME Part B · Clinic/Group PracticeDue dateNovember 30, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Boulder Plastic Surgery Prof LLC, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Ronald Hartley, MD
Plastic and Reconstructive Surgery
NPI 1649208646
1215 SPRUCE ST STE 201
Boulder, CO 80302
(303) 443-2277
✔ PECOS✔ Accepts Medicare2.3 mi
Justin Maxhimer, M.D.
Plastic and Reconstructive Surgery
NPI 1720138639
1215 SPRUCE ST STE 201
Boulder, CO 80302
(303) 443-2277
✔ PECOS✔ Accepts Medicare2.3 mi
Joshua Rouch, M.D.
Plastic and Reconstructive Surgery
NPI 1801153572
1215 SPRUCE ST STE 201
Boulder, CO 80302
(303) 443-2277
✔ PECOS✔ Accepts Medicare2.3 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 06D2197453

Boulder Plastic Surgery, PLLC · Boulder, CO
Active · expires Oct 25, 2026
CLIA Number06D2197453
Laboratory TypePhysician Office
Certificate Effective DateOctober 26, 2024
Certificate Expiration DateOctober 25, 2026
Laboratory DirectorDr. Justin B. Maxhimer
Laboratory Phone(303) 443-2277
Laboratory LocationBoulder Plastic Surgery, PLLC2525 4th Street, Suite 200, Boulder, CO 80304
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Boulder Plastic Surgery Prof LLC's NPI number?

The NPI number for Boulder Plastic Surgery Prof LLC is 1033705926. It was assigned to this organization in the NPPES registry on December 15, 2020.

Where is Boulder Plastic Surgery Prof LLC located?

Boulder Plastic Surgery Prof LLC is located at 4747 Arapahoe Ave, Boulder, CO 80303. The listed phone number is (720) 854-7000.

What is Boulder Plastic Surgery Prof LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Boulder Plastic Surgery Prof LLC enrolled in Medicare?

Yes. Boulder Plastic Surgery Prof LLC is registered in the Medicare PECOS enrollment system.

When is Boulder Plastic Surgery Prof LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Colorado, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Boulder Plastic Surgery Prof LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Plastic and Reconstructive Surgery, reassign their Medicare billing to Boulder Plastic Surgery Prof LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Boulder Plastic Surgery Prof LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 06D2197453) is associated with this NPI, valid through October 25, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Boulder Plastic Surgery Prof LLC was last updated on December 15, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.