Benjamin Miceli, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0003875 Issued in CO

Practice address

1107 S Lemay Ave
Suite 240
Fort Collins, CO 80524-3960

Phone

(970) 495-7421

Fax

(970) 495-7424

NPI assigned

Jan 22, 2014

Last updated

Sep 18, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Poudre Valley Medical Group, LLC

  dba UCHealth Medical Group

  • General Practice Physician
  • Loveland, CO
  • NPI 1225356868
  Medicare reassignment NPD
• Advanced Neurology of Colorado, LLC

  • Specialist
  • Fort Collins, CO
  • NPI 1972556991
  Medicare reassignment
• Advanced Neurology of Colorado, LLC

  • Neurology Physician
  • Longmont, CO
  • NPI 1386365641
  NPD
• Poudre Valley Medical Group, LLC

  dba UCHealth Medical Group

  • General Practice Physician
  • Loveland, CO
  • NPI 1366763260
  NPD

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

{
    "created_epoch": "1390348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1043633324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 S LEMAY AVE",
            "address_2": "SUITE 240",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805243960",
            "telephone_number": "970-495-7421",
            "fax_number": "970-495-7424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 S LEMAY AVE",
            "address_2": "SUITE 240",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805243960",
            "telephone_number": "970-495-7421",
            "fax_number": "970-495-7424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICELI",
        "first_name": "BENJAMIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-22",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "0003875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14330318",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lin Meyer, M.A.
• Jeremy Joseph Meyer, P.T.
• MH Health Care Services, PC
• MH Health Care Services, PC
• Danielle N. Mianzo
• Kara Lynn Micetich, MD
• Donna Micheaux
• Melody Maria Michel, LMT
• Elizabeth Michell, M.D.
• Michelle Garcia LMFT

• Physician Assistant in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.