NPIMap

Individual provider Active NPI

Ernestine Malabanan Keh, MS PA-C

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1093147688
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0007713 Issued in CO
Practice address
1400 E Boulder St
Colorado Springs, CO 80909-5533
Phone
(719) 365-1292
Fax
(719) 365-6997
NPI assigned
Aug 6, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 25MP00311400 NJ
Physician Assistant 363A00000X PA.0007713 CO Primary

Addresses

Primary practice location

1400 E Boulder St
Colorado Springs, CO 80909-5533

Mailing address

1400 E Boulder St
Colorado Springs, CO 80909-5533
Phone (719) 365-1292

Other practice location 1

727 State Rd
Montgomery Internal medicine group
Princeton, NJ 08540-1444
Phone (609) 921-6410

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
I20230130000713 CO Practitioner - Physician Assistant 2769616366 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
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)

1400 E Boulder
Suite 2410 Pre Procedure Memorial
Colorado Springs, CO 80909-5533
Phone (719) 365-6525

1400 E Boulder St
Colorado Springs, CO 80909-5533

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

Hospital & facility affiliations

  • Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.0007713COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jan 30, 2023 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jan 30, 2023 Accepting new patients

Locations

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

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

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

1400 E Boulder St
Ste 2508
Colorado Springs, CO 80909
Phone (719) 365-1292

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

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1375747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1093147688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E BOULDER ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095533",
            "telephone_number": "719-365-1292",
            "fax_number": "719-365-6997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E BOULDER ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095533",
            "telephone_number": "719-365-1292",
            "fax_number": "719-365-6997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "727 State Rd",
            "address_2": "Montgomery Internal medicine group",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "NJ",
            "postal_code": "085401444",
            "country_code": "US",
            "telephone_number": "609-921-6410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEH",
        "first_name": "ERNESTINE",
        "middle_name": "MALABANAN",
        "credential": "MS PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-06",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00311400",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0007713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.