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BOULDER PLASTIC SURGERY PROF LLC
NPI 1497341754
Specialist in Boulder, CO

Active since December 21, 2020
1100 BALSAM AVE, BOULDER, CO 80304(303) 440-2273 Get Directions Write a Review

NPPES record last updated: December 21, 2020. Verified against the NPPES registry weekly; last sync: October 25, 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 1497341754) is a healthcare organization registered as a specialist in Boulder, Colorado and active in the NPI registry since December 2020. The organization lists Pam Garcia, Office Contact, as its authorized official.

NPPES Registry Identity

NPI1497341754
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameBOULDER PLASTIC SURGERY PROF LLC
Location Address1100 BALSAM AVEBoulder, CO 80304-3404
Mailing AddressPo Box 7643Loveland, CO 80537-0643 · (970) 663-2742 · Fax (970) 342-2093
Phone(303) 440-2273
Organization SubpartNo
Authorized OfficialPam GarciaOffice Contact · (303) 443-2277
Enumeration DateDecember 21, 2020
NPPES CertifiedDecember 15, 2020
✔ NPI 1497341754 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.
1100 BALSAM AVE, Boulder, CO 80304
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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 Medicare0.5 mi
Justin Maxhimer, M.D.
Plastic and Reconstructive Surgery
NPI 1720138639
1215 SPRUCE ST STE 201
Boulder, CO 80302
(303) 443-2277
✔ PECOS✔ Accepts Medicare0.5 mi
Joshua Rouch, M.D.
Plastic and Reconstructive Surgery
NPI 1801153572
1215 SPRUCE ST STE 201
Boulder, CO 80302
(303) 443-2277
✔ PECOS✔ Accepts Medicare0.5 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 Boulder Plastic Surgery Prof LLC's NPI number?

The NPI number for Boulder Plastic Surgery Prof LLC is 1497341754. It was assigned to this organization in the NPPES registry on December 21, 2020.

Where is Boulder Plastic Surgery Prof LLC located?

Boulder Plastic Surgery Prof LLC is located at 1100 Balsam Ave, Boulder, CO 80304. The listed phone number is (303) 440-2273.

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.

When was this NPI record last updated?

The NPPES record for Boulder Plastic Surgery Prof LLC was last updated on December 21, 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.