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IDEAL FAMILY MEDICINE, LTD
NPI 1255865713
Nurse Practitioner - Family in Pueblo, CO

Active since April 11, 2017
1910 LAKE AVE, PUEBLO, CO 81004(719) 582-1489(719) 434-9807 Get Directions Write a Review

NPPES record last updated: March 4, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 4, 2024, Apr 9, 2021, Apr 11, 2017 (3 updates tracked since 2017).

About Ideal Family Medicine, Ltd NPPES

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

IDEAL FAMILY MEDICINE, LTD (NPI 1255865713) is a healthcare organization registered as a family in Pueblo, Colorado and active in the NPI registry since April 2017. The organization lists Jade Bryant, Owner, as its authorized official.

NPPES Registry Identity

NPI1255865713
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameIDEAL FAMILY MEDICINE, LTD
Location Address1910 LAKE AVEPueblo, CO 81004-3322
Mailing Address19 E Abarr Dr # 200Pueblo, CO 81007-5436 · (719) 582-1489 · Fax (719) 434-9807
Phone(719) 582-1489
Fax(719) 434-9807
Organization SubpartNo
Authorized OfficialJade BryantOwner · (719) 582-1489
Enumeration DateApril 11, 2017
Last NPPES UpdateMarch 4, 20243 updates tracked since enumeration
NPPES CertifiedMarch 4, 2024
✔ NPI 1255865713 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in CO · 0992962
1910 LAKE AVE, Pueblo, CO 81004
Open in Google Maps ↗

Other Identifiers 1

Medicaid1154861995CO

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ideal Family Medicine, Ltd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Ideal Family Medicine, Ltd, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Jade Bryant, FNP-BC
Nurse Practitioner
NPI 1154861995
1910 LAKE AVE
Pueblo, CO 81004
(719) 582-1489
✔ PECOS✔ Accepts MedicareSame address
Danielle Kizzie, FNP-C
Nurse Practitioner
NPI 1780460592
3676 PARKER BLVD
Pueblo, CO 81008
(719) 553-2201
✔ PECOS✔ Accepts Medicare5.4 mi

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

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 Ideal Family Medicine, Ltd's NPI number?

The NPI number for Ideal Family Medicine, Ltd is 1255865713. It was assigned to this organization in the NPPES registry on April 11, 2017.

Where is Ideal Family Medicine, Ltd located?

Ideal Family Medicine, Ltd is located at 1910 Lake Ave, Pueblo, CO 81004. The listed phone number is (719) 582-1489.

What is Ideal Family Medicine, Ltd's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Ideal Family Medicine, Ltd enrolled in Medicare?

Yes. Ideal Family Medicine, Ltd is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Ideal Family Medicine, Ltd?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Ideal Family Medicine, Ltd. 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, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Ideal Family Medicine, Ltd was last updated on March 4, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.