NPI 1588621445 · Physician Assistant · Kpic
Strong multi-source corroboration of active practice across 2 carrier networks with confirmed Colorado DORA license.
NPPES
BOULDER, 80304
Freshness: Unknown
Network Status
Listed with 2 carriers
DORA License
Active
Medicare
3,137 services
193 beneficiaries
$32,175.45 total payment
Specialty: Physician Assistant
Care Compare
Address mismatch with NPPES
PECOS Enrollment
Medicare enrolled
Order/Referring eligible: Yes
Active NPI with specialty classification
Active Colorado DORA license confirmed
Active Medicare billing confirmed
Single address source (NPPES)
Limited carrier network presence
2 networks across 1 carrier
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.