Active NPI
Mary Bailey Tribble, PA-C
- Physician Assistant
- Broomfield, CO
National Provider Identifier
1033855796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA.0007327
- Practice address
- 1260 E 1St Ave Unit a
Broomfield, CO 80020-3792 - Phone
- (720) 716-4518
- NPI assigned
- May 6, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA.0007327 | CO | Primary |
Addresses
Primary practice location
1260 E 1St Ave Unit a
Broomfield, CO 80020-3792
Mailing address
PO Box 183
Round Top, TX 78954-0183
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA.0007327 | CO | MD | Physician Assistant |
Interoperability endpoints
- mary.tribble.1@25213.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651795200000",
"number": "1033855796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 183",
"city": "ROUND TOP",
"state": "TX",
"postal_code": "789540183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1260 E 1ST AVE UNIT A",
"city": "BROOMFIELD",
"state": "CO",
"postal_code": "800203792",
"telephone_number": "720-716-4518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRIBBLE",
"first_name": "MARY",
"middle_name": "BAILEY",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-06",
"last_updated": "2022-05-06",
"certification_date": "2022-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "PA.0007327",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broomfield, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.