SOCO PRIMARY CARE CLINIC
NPI 1124677729
Nurse Practitioner - Adult Health in Pueblo, CO
About Soco Primary Care Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOCO PRIMARY CARE CLINIC (NPI 1124677729) is a healthcare organization registered as an adult health in Pueblo, Colorado and active in the NPI registry since September 2019. The organization holds a CLIA Waiver certificate valid through October 7, 2027 and lists Nicole Lynn Betts, President, Authorized Official, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Soco Primary Care Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Soco Primary Care Clinic, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
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 06D2173237
Soco Primary Care Clinic · Pueblo, COFrequently 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 Soco Primary Care Clinic's NPI number?
The NPI number for Soco Primary Care Clinic is 1124677729. It was assigned to this organization in the NPPES registry on September 6, 2019.
Where is Soco Primary Care Clinic located?
Soco Primary Care Clinic is located at 1310 Fortino Blvd Ste D, Pueblo, CO 81008. The listed phone number is (719) 582-1898.
What is Soco Primary Care Clinic's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.
Is Soco Primary Care Clinic enrolled in Medicare?
Yes. Soco Primary Care Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Soco Primary Care Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Soco Primary Care Clinic. 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, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Soco Primary Care Clinic hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 06D2173237) is associated with this NPI, valid through October 7, 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 Soco Primary Care Clinic was last updated on April 30, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Soco Primary Care Clinic · NPI 1124677729
Adult Health organization in Pueblo, Colorado. Organization record, active in the CMS NPPES registry since September 6, 2019.
## Identity
- **NPI:** 1124677729 (Entity type: Organization)
- **Enumerated:** September 6, 2019
- **Primary specialty:** Nurse Practitioner - Adult Health · taxonomy 363LA2200X
- **Organization subpart:** No
- **Authorized official:** Nicole Betts, PRESIDENT, AUTHORIZED OFFICIAL
## Practice location
- **Address:** 1310 FORTINO BLVD STE D, Pueblo, CO 81008-2076
- **Phone:** (719) 582-1898 · **Fax:** (719) 621-4098
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 30, 2020
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1124677729) · Data from the CMS NPPES public registry.