NPIMap

Individual provider Active NPI

Amanda Meree Gibson, NURSE PRACTITIONER

  • Nurse Practitioner
  • Colorado Springs, CO
National Provider Identifier
1023773884
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APN.0996653-NP Issued in CO
Practice address
525 Bob Peters GRV Ste 309
Colorado Springs, CO 80909-4533
Phone
(719) 365-6464
NPI assigned
Nov 5, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APN.0996653-NP CO Primary

Addresses

Primary practice location

525 Bob Peters GRV Ste 309
Colorado Springs, CO 80909-4533

Mailing address

525 Bob Peters GRV Ste 309
Colorado Springs, CO 80909-4533
Phone (719) 365-6464

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
I20211223001210 CO Practitioner - Nurse Practitioner 3870984081 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

525 Bob Peters GRV
Suite 309
Colorado Springs, CO 80909-4533
Phone (719) 365-6464

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APN.0996653-NPCOMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Feb 13, 2022 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Feb 13, 2022 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

3843 Rio Vista Dr
Ste 2700
Colorado Springs, CO 80917
Phone (719) 364-5080

3843 Rio Vista Dr
Ste 2100
Colorado Springs, CO 80917
Phone (719) 364-5250

525 Bob Peters Grv
Ste 309UC
Colorado Springs, CO 80909
Phone (719) 365-6464

525 Bob Peters Grv
Ste 309
Colorado Springs, CO 80909
Phone (719) 365-6464

1625 Medical Center Pt
Ste 220
Colorado Springs, CO 80907
Phone (719) 364-5080

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 2

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

Hospital & facility affiliations 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1636070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1023773884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 BOB PETERS GRV STE 309",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809094533",
            "telephone_number": "719-365-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 BOB PETERS GRV STE 309",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809094533",
            "telephone_number": "719-365-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "AMANDA",
        "middle_name": "MEREE",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-05",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "APN.0996653-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.