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EVERGREEN CONIFER PEDIATRICS
NPI 1689839144
Pediatrics in Evergreen, CO

Active since July 24, 2008CLIA 06D0515466 · Waiver
30960 STAGECOACH BLVD, SUITE W-120, EVERGREEN, CO 80439(303) 674-6671(303) 674-0031 Get Directions Write a Review

NPPES record last updated: July 24, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Evergreen Conifer Pediatrics NPPES

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

EVERGREEN CONIFER PEDIATRICS (NPI 1689839144) is a healthcare organization registered as a pediatrics in Evergreen, Colorado and active in the NPI registry since July 2008. The organization holds a CLIA Waiver certificate valid through June 8, 2027 and lists Kenneth John Kutalek, Owner, as its authorized official.

NPPES Registry Identity

NPI1689839144
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameEVERGREEN PEDIATRICS, LLC
Location Address30960 STAGECOACH BLVD, SUITE W-120Evergreen, CO 80439-7902
Mailing Address30960 Stagecoach Blvd, Suite W-120Evergreen, CO 80439-7902 · (303) 674-6671 · Fax (303) 674-0031
Phone(303) 674-6671
Fax(303) 674-0031
Organization SubpartNo
Authorized OfficialKenneth John KutalekOwner · (303) 674-6671
Enumeration DateJuly 24, 2008
✔ NPI 1689839144 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CO · 26133
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
30960 STAGECOACH BLVD, Evergreen, CO 80439
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Other Names 1

Doing Business AsEvergreen Conifer Pediatrics

Other Identifiers 5

Medicaid01261338CO
Medicare UPIND24795CO
Medicare UPIND24757CO
Medicaid04007977CO
Medicaid40308332CO

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

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 06D0515466

Evergreen Pediatrics · Evergreen, CO
Active · expires Jun 8, 2027
CLIA Number06D0515466
Laboratory TypePhysician Office
Certificate Effective DateJune 9, 2025
Certificate Expiration DateJune 8, 2027
Laboratory DirectorKenneth J. Kutalek
Laboratory Phone(303) 674-6671
Laboratory LocationEvergreen Pediatrics30960 Stagecoach Blvd Ste 120, Evergreen, CO 80439
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

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

DANIEL R. HOCK O.D.
Optometrist
30960 STAGECOACH BLVD, STE W-200
EVERGREEN, CO 80439
Jefferson County (303) 674-4143
ADVANCED DERMATOLOGY SKIN CANCER & LASER SURGERY CENTER P.C.
Dermatology
30960 STAGECOACH BLVD, STE W140
EVERGREEN, CO 80439
Jefferson County (303) 670-7065
DR. KENNETH JOHN KUTALEK MD
Pediatrics
30960 STAGECOACH BLVD, SUITE W120
EVERGREEN, CO 80439
Jefferson County (303) 674-6671
DR. RUDOLF THOMAS SCHMIEDT I MD
Pediatrics
30960 STAGECOACH BLVD, SUITE W-120
EVERGREEN, CO 80439
Jefferson County (303) 674-6671
KATHRYN RASMUSSEN PA-C
Physician Assistant (Medical)
30960 STAGECOACH BLVD, STE 120
EVERGREEN, CO 80439
Jefferson County (303) 674-6671
DR. PAUL DENNIS REGAN D.M.D.
Dentist (Orthodontics and Dentofacial Orthopedics)
30960 STAGECOACH BLVD, W100
EVERGREEN, CO 80439
Jefferson County (303) 674-1122
D MALCOLM STRANGE DDS MSD PC
Dentist (Pediatric Dentistry)
30960 STAGECOACH BLVD, SUITE W100
EVERGREEN, CO 80439
Jefferson County (303) 670-7070

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 Evergreen Pediatrics, LLC's NPI number?

The NPI number for Evergreen Pediatrics, LLC is 1689839144. It was assigned to this organization in the NPPES registry on July 24, 2008. The provider is doing business as Evergreen Conifer Pediatrics.

Where is Evergreen Pediatrics, LLC located?

Evergreen Pediatrics, LLC is located at 30960 Stagecoach Blvd Suite W-120, Evergreen, CO 80439. The listed phone number is (303) 674-6671.

What is Evergreen Pediatrics, LLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Evergreen Pediatrics, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 06D0515466) is associated with this NPI, valid through June 8, 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 Evergreen Pediatrics, LLC was last updated on July 24, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.