NPIMap

Individual provider Active NPI

Kristine Salazar Pacheco, PA-C

  • Physician Assistant
  • Denver, CO
National Provider Identifier
1083654859
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1850 Issued in CO
Practice address
100 Cook St Ste 306
Denver, CO 80206-5339
Phone
(720) 516-9400
Fax
(719) 365-6094
NPI assigned
Jun 8, 2006
Last updated
Jun 25, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-1850 CO Primary

Addresses

Primary practice location

100 Cook St Ste 306
Denver, CO 80206-5339

Mailing address

8890 N Union Blvd
Ste 160
Colorado Springs, CO 80920-7799
Phone (719) 365-9950

Other identifiers 1

IdentifierTypeStateIssuer
18689043MedicaidCO

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
I20040129000226 CO Practitioner - Physician Assistant 7315840162 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
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)

100 Cook St
Denver, CO 80206-5339

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
PA-1850COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Oct 1, 2012 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Oct 1, 2012 Accepting new patients
Poudre Valley Medical Group, LLC Past Accepting new patients

Locations

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

1725 E Boulder St
Ste 101
Colorado Springs, CO 80909
Phone (719) 365-6300

8890 N Union Blvd
Ste 160
Colorado Springs, CO 80920
Phone (719) 364-8840

100 Cook St
Ste 306
Denver, CO 80206
Phone (720) 516-9400

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

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 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1083654859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8890 N UNION BLVD",
            "address_2": "STE 160",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207799",
            "telephone_number": "719-365-9950",
            "fax_number": "719-365-9969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COOK ST STE 306",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802065339",
            "telephone_number": "720-516-9400",
            "fax_number": "719-365-6094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACHECO",
        "first_name": "KRISTINE",
        "middle_name": "SALAZAR",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA-1850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18689043",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.