1. Home
  2. Directory
  3. Colorado
  4. Loveland
  5. Clinic Center
  6. NPI Profile

BANNER FORT COLLINS PCP LLC
NPI 1104616390
Clinic/Center - Multi-Specialty in Loveland, CO

Active since May 09, 2025CLIA 06D2327686 · Waiver
1625 FOXTRAIL DR STE 190, LOVELAND, CO 80538(970) 500-2244 Get Directions Write a Review

NPPES record last updated: July 30, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 29, 2025, May 9, 2025 (2 updates tracked since 2025).

About Banner Fort Collins Pcp Llc NPPES

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

BANNER FORT COLLINS PCP LLC (NPI 1104616390) is a healthcare organization registered as a multi-specialty in Loveland, Colorado and active in the NPI registry since May 2025. The organization holds a CLIA Waiver certificate valid through July 27, 2027 and lists Shiva Birdi, Ceo, as its authorized official.

NPPES Registry Identity

NPI1104616390
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameBANNER FORT COLLINS PCP LLC
Location Address1625 FOXTRAIL DR STE 190Loveland, CO 80538-9089
Mailing Address2901 N Central Ave Ste 160Phoenix, AZ 85012-2702
Phone(970) 500-2244
Organization SubpartYesParent: Banner Health
Authorized OfficialShiva BirdiCeo · (602) 747-4000
Enumeration DateMay 9, 2025
Last NPPES UpdateJuly 30, 20252 updates tracked since enumeration
NPPES CertifiedJuly 30, 2025
✔ NPI 1104616390 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X
1625 FOXTRAIL DR STE 190, Loveland, CO 80538
Open in Google Maps ↗

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 06D2327686

Banner For Collins Pcp LLC · Fort Collins, CO
Active · expires Jul 27, 2027
CLIA Number06D2327686
Laboratory TypePhysician Office
Certificate Effective DateJuly 28, 2025
Certificate Expiration DateJuly 27, 2027
Laboratory DirectorBrett G. Masayesva
Laboratory Phone(970) 500-2244
Laboratory LocationBanner For Collins Pcp LLC1625 Foxtrail Dt Suite 190, Fort Collins, CO 80538
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARGARITE ANNE BECHIS MD
Family Medicine
1625 FOXTRAIL DR STE 190
LOVELAND, CO 80538
Larimer County (970) 619-6900
DR. ANN T DAVIES M.D.
Family Medicine
1625 FOXTRAIL DR STE 190
LOVELAND, CO 80538
Larimer County (970) 619-6900
VMD PRIMARY PROVIDERS COLORADO, INC
Clinic/Center (Primary Care)
1625 FOXTRAIL DR STE 190
LOVELAND, CO 80538
Larimer County (970) 619-6900
MATTHEW EMMETT HARRIS PA-C
Physician Assistant
1625 FOXTRAIL DR STE 190
LOVELAND, CO 80538
Larimer County (970) 619-6900
ROCHELLE MARIE PALMISCNO M.D.
Family Medicine
1625 FOXTRAIL DR STE 190
LOVELAND, CO 80538
Larimer County (970) 619-6900
DR. BRETT GORDON MASAYESVA M.D.
Family Medicine
1625 FOXTRAIL DR STE 190
LOVELAND, CO 80538
Larimer County (970) 500-2244
DR. DAPHNE KAE ROMMEREIM-MADDEN MD
Family Medicine
1625 FOXTRAIL DR STE 190
LOVELAND, CO 80538
Larimer County (970) 500-2244
DR. DERIC MCINTOSH D.O.
Family Medicine
1625 FOXTRAIL DR STE 190
LOVELAND, CO 80538
Larimer County (970) 619-6900

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 Banner Fort Collins Pcp LLC's NPI number?

The NPI number for Banner Fort Collins Pcp LLC is 1104616390. It was assigned to this organization in the NPPES registry on May 9, 2025.

Where is Banner Fort Collins Pcp LLC located?

Banner Fort Collins Pcp LLC is located at 1625 Foxtrail Dr Ste 190, Loveland, CO 80538. The listed phone number is (970) 500-2244.

What is Banner Fort Collins Pcp LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Banner Fort Collins Pcp LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 06D2327686) is associated with this NPI, valid through July 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Banner Fort Collins Pcp LLC was last updated on July 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.