Individual provider Active NPI

Marisa Lynn Brightman, PA-C

  • Medical Physician Assistant
  • Aurora, CO
National Provider Identifier
1063770246
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.0003379 Issued in CO
Practice address
12605 E 16TH Ave
Aurora, CO 80045
Phone
(720) 848-0000
NPI assigned
Apr 25, 2012
Last updated
Oct 23, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3379 CO
Medical Physician Assistant 363AM0700X PA.0003379 CO Primary

Addresses

Primary practice location

12605 E 16TH Ave
Aurora, CO 80045

Mailing address

PO Box 110429
Aurora, CO 80042-0429
Phone (303) 493-7000

Other names 1

  • Marisa Lynn Ditullio Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120731000430 CO Practitioner - Physician Assistant 5496911703 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3379COMDPhysician Assistant
PA.0003379COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians Incorporated CurrentSince May 15, 2012 Accepting new patients
University Physicians, Incorporated CurrentSince May 15, 2012 Accepting new patients
University Physicians Incorporated Physician Assistant Past Accepting new patients

Locations

12605 E 16th Ave
Aurora, CO 80045
Phone (720) 848-0006

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

1665 Aurora Ct
Aurora, CO 80045
Phone (720) 848-0300

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.

NPI Registry JSON

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540252800000",
    "number": "1063770246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110429",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800420429",
            "telephone_number": "303-493-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12605 E 16TH AVE",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "80045",
            "telephone_number": "720-848-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIGHTMAN",
        "first_name": "MARISA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-25",
        "last_updated": "2018-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "3379",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0003379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "DITULLIO",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.