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CREEKSIDE PHYSICAL MEDICINE PLLC
NPI 1578601969
Neuromusculoskeletal Medicine & OMM in Boulder, CO

Active since February 01, 2007
5387 MANHATTAN CIR, STE 201, BOULDER, CO 80303(303) 494-2705(303) 494-2706 Get Directions Write a Review

NPPES record last updated: August 4, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Creekside Physical Medicine Pllc NPPES

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

CREEKSIDE PHYSICAL MEDICINE PLLC (NPI 1578601969) is a healthcare organization registered as a neuromusculoskeletal medicine & omm in Boulder, Colorado and active in the NPI registry since February 2007. The organization lists David E Tanner, Principal Clinician, as its authorized official.

NPPES Registry Identity

NPI1578601969
Entity TypeOrganization
Primary Taxonomy204D00000X
Legal Business NameCREEKSIDE PHYSICAL MEDICINE PLLC
Location Address5387 MANHATTAN CIR, STE 201Boulder, CO 80303-4284
Mailing Address5387 Manhattan Cir, Ste 201Boulder, CO 80303-4284 · (303) 494-2705 · Fax (303) 494-2706
Phone(303) 494-2705
Fax(303) 494-2706
Organization SubpartNo
Authorized OfficialDavid E TannerPrincipal Clinician · (303) 494-2705
Enumeration DateFebruary 1, 2007
Last NPPES UpdateAugust 4, 2025
NPPES CertifiedAugust 4, 2025
✔ NPI 1578601969 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNeuromusculoskeletal Medicine & OMMAllopathic & Osteopathic Physicians
Taxonomy Code204D00000X
License✔ Licensed in CO · 38635
Definition
The Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician directs special attention to the neuromusculoskeletal system and its interaction with other body systems. Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine encompasses increased knowledge and understanding of osteopathic principles and practice and heightened technical skills of osteopathic manipulative medicine, and integrates each of these into the management of pediatric, adolescent, adult, and geriatric patients.
5387 MANHATTAN CIR, Boulder, CO 80303
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-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)

Creekside Physical Medicine Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Creekside Physical Medicine PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

David Tanner, DO
Physical Medicine and Rehabilitation
NPI 1609897578
5387 MANHATTAN CIR SUITE 201
Boulder, CO 80303
(303) 494-2705
✔ PECOS✔ Accepts MedicareSame address

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 Creekside Physical Medicine PLLC's NPI number?

The NPI number for Creekside Physical Medicine PLLC is 1578601969. It was assigned to this organization in the NPPES registry on February 1, 2007.

Where is Creekside Physical Medicine PLLC located?

Creekside Physical Medicine PLLC is located at 5387 Manhattan Cir Ste 201, Boulder, CO 80303. The listed phone number is (303) 494-2705.

What is Creekside Physical Medicine PLLC's specialty?

The primary specialty registered for this NPI is Neuromusculoskeletal Medicine & OMM with taxonomy code 204D00000X.

Is Creekside Physical Medicine PLLC enrolled in Medicare?

Yes. Creekside Physical Medicine PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Creekside Physical Medicine PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Physical Medicine and Rehabilitation) reassigns their Medicare billing to Creekside Physical Medicine PLLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Creekside Physical Medicine PLLC was last updated on August 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.