Active NPI
Thomas E Shonka, DPM
- Sports Medicine Podiatrist
- Boulder, CO
National Provider Identifier
1013929660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine Podiatrist
- License
- CO335
- Practice address
- 1400 28TH St
Suite 2
Boulder, CO 80303-1096 - Phone
- (303) 449-2000
- Fax
- (303) 449-9475
- NPI assigned
- Aug 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Podiatric Medicine Podiatrist | 213EP1101X | CO335 | CO | |
| Sports Medicine Podiatrist | 213ES0000X | CO335 | CO | Primary |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | CO335 | CO |
Addresses
Primary practice location
1400 28TH St
Suite 2
Boulder, CO 80303-1096
Mailing address
1400 28TH St
Suite 2
Boulder, CO 80303-1096
Phone (303) 449-2000
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01003359 | Medicaid | CO | |
| 841514106 03 | Other | CO | PACIFICARE PROVIDER # |
| 841514106 002 | Other | CO | ROCKY MNT HEALTH PLANS |
| SH36054 | Other | CO | BCBS PROVIDER # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO335 | CO | MD | Sports Medicine Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318809600000",
"number": "1013929660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 28TH ST",
"address_2": "SUITE 2",
"city": "BOULDER",
"state": "CO",
"postal_code": "803031096",
"telephone_number": "303-449-2000",
"fax_number": "303-449-9475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 28TH ST",
"address_2": "SUITE 2",
"city": "BOULDER",
"state": "CO",
"postal_code": "803031096",
"telephone_number": "303-449-2000",
"fax_number": "303-449-9475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHONKA",
"first_name": "THOMAS",
"middle_name": "E",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-12",
"last_updated": "2011-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "213EP1101X",
"taxonomy_group": "",
"desc": "Podiatrist, Primary Podiatric Medicine",
"state": "CO",
"license": "CO335",
"primary": false
},
{
"code": "213ES0000X",
"taxonomy_group": "",
"desc": "Podiatrist, Sports Medicine",
"state": "CO",
"license": "CO335",
"primary": true
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "CO",
"license": "CO335",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01003359",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFICARE PROVIDER #",
"identifier": "841514106 03",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ROCKY MNT HEALTH PLANS",
"identifier": "841514106 002",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER #",
"identifier": "SH36054",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.