NPIMap

Individual provider Active NPI

Kevin W Hanley, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Boulder, CO
National Provider Identifier
1003877390
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
16965 Issued in CO
Practice address
1100 Balsam Ave
Boulder, CO 80304-3404
Phone
(303) 440-2273
NPI assigned
Mar 28, 2006
Last updated
Mar 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 16965 CO Primary

Addresses

Primary practice location

1100 Balsam Ave
Boulder, CO 80304-3404

Mailing address

42 Garden Ctr
Broomfield, CO 80020-1730
Phone (303) 465-0401

Other practice location 1

4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 465-0401

Other identifiers 2

IdentifierTypeStateIssuer
220020716OtherCORAILROAD MEDICARE
01169655MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100512000584 CO Practitioner - Pathology 1759472723 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Louisville School of Medicine, 1969
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Valley Pathology P CGroup PAC ID 8527957927, 4 clinicians

Practice addresses (Care Compare)

4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (720) 854-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
16965COMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Valley Pathology P C Anatomic Pathology & Clinical Pathology CurrentSince Jan 1, 1975 Accepting new patients

Locations

1100 Balsam Ave
Boulder, CO 80304
Phone (303) 415-7000

4747 Arapahoe Ave
Boulder, CO 80303
Phone (303) 415-7000

36 Garden Ctr
Broomfield, CO 80020
Phone (303) 465-0401

42 Garden Ctr
Broomfield, CO 80020

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 64

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 64

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1003877390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 GARDEN CTR",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800201730",
            "telephone_number": "303-465-0401",
            "fax_number": "303-438-1351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 BALSAM AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043404",
            "telephone_number": "303-440-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4747 Arapahoe Ave",
            "address_purpose": "LOCATION",
            "city": "Boulder",
            "state": "CO",
            "postal_code": "803031131",
            "country_code": "US",
            "telephone_number": "303-465-0401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANLEY",
        "first_name": "KEVIN",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CO",
            "license": "16965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "220020716",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01169655",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.