NPIMap

Individual provider Active NPI

Bradley Philip Coughlin, PA-C

  • Medical Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1053399451
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2850 Issued in CO
Practice address
2767 Janitell Rd
Colorado Springs, CO 80906-4102
Phone
(719) 365-2888
NPI assigned
Jan 5, 2006
Last updated
May 12, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 0110002173 VA
Medical Physician Assistant 363AM0700X 2850 CO Primary

Addresses

Primary practice location

2767 Janitell Rd
Colorado Springs, CO 80906-4102

Mailing address

1650 Cochrane Cir BLDG 7505
Credentials Office RM # 163
Colorado Springs, CO 80913-4613
Phone (719) 526-2092

Other identifiers 3

IdentifierTypeStateIssuer
TN0141OtherVAJOHN DEERE HEALTH
010213355MedicaidVA
P00306338OtherVARAILROAD MEDICARE

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
I20100722000627 CO Practitioner - Physician Assistant 5597786459 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

13445 Voyager Pkwy
Colorado Springs, CO 80921-7648
Phone (719) 219-0333

2767 Janitell Rd
Colorado Springs, CO 80906-4102
Phone (719) 365-2888

2773 Janitell Rd
Colorado Springs, CO 80906-4102
Phone (719) 591-2558

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110002173VAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Apr 3, 2017 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Apr 3, 2017 Accepting new patients
Uch-MHS Past Accepting new patients

Locations

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

1035 Garden of the Gods Rd
Ste 120
Colorado Springs, CO 80907
Phone (719) 329-1000

13445 Voyager Pkwy
Colorado Springs, CO 80921
Phone (719) 219-0333

1400 E Boulder St
Colorado Springs, CO 80909
Phone (719) 365-5120

2767 Janitell Rd
Colorado Springs, CO 80906
Phone (719) 365-2888

4323 Integrity Center Pt
Colorado Springs, CO 80917
Phone (719) 591-2558

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

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

11605 Meridian Market Vw
Ste 184
Peyton, CO 80831
Phone (719) 364-9555

Organizations & group practices 3

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589241600000",
    "number": "1053399451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 COCHRANE CIR BLDG 7505",
            "address_2": "CREDENTIALS OFFICE RM # 163",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809134613",
            "telephone_number": "719-526-2092",
            "fax_number": "719-526-7732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2767 JANITELL RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064102",
            "telephone_number": "719-365-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUGHLIN",
        "first_name": "BRADLEY",
        "middle_name": "PHILIP",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": "0110002173",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "2850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH",
            "identifier": "TN0141",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010213355",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00306338",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.