NPI 1104594183 · Physician Assistant · Anthem
Strong multi-source corroboration of active practice across 8 carrier networks with confirmed Colorado DORA license.
NPPES
BOULDER, 80303
Freshness: Unknown
Network Status
Listed with 9 carriers
DORA License
Active
Medicare
Not enrolled in Medicare (PECOS)
162 beneficiaries
$22,275.65 total payment
Specialty: Physician Assistant
Care Compare
Address mismatch with NPPES
Active NPI with specialty classification
Active Colorado DORA license confirmed
Active Medicare billing confirmed
Single address source (NPPES)
Listed in multiple carrier networks
8 networks across 3 carriers
Strong network presence across 8 carrier networks with corroborating federal activity signals.
Disclaimer: This analysis uses publicly available federal and state data sources. It does not constitute a determination of provider status or network participation. Contact the provider or health plan directly to verify current status.
PECOS Enrollment
No PECOS data