NPIMap

Individual provider Active NPI

Katherine Berdell, P.A.-C

  • Physician Assistant
  • Fort Collins, CO
National Provider Identifier
1104065218
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2121 E Harmony Rd Unit 170
Fort Collins, CO 80528
Phone
(970) 493-6337
Fax
(970) 493-3528
NPI assigned
Feb 12, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA.0005386 CO
Surgical Physician Assistant 363AS0400X PA08433 TX
Surgical Physician Assistant 363AS0400X 013102 NY
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2121 E Harmony Rd Unit 170
Fort Collins, CO 80528

Mailing address

2121 E Harmony Rd Unit 170
Fort Collins, CO 80528-3413
Phone (970) 493-6337

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
I20180627002713 CO Practitioner - Physician Assistant 9133361843 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1024 S Lemay Ave
Fort Collins, CO 80524-3929

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

2121 E Harmony Rd
Fort Collins, CO 80528-3413

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

Hospital & facility affiliations

  • Poudre Valley Hospital Hospital, Fort Collins, CO, CCN 060010
  • Medical Center of the Rockies Hospital, Loveland, CO, CCN 060119
  • Uchealth Greeley Hospital Hospital, Greeley, CO, CCN 060131

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA08433TXMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jul 30, 2018 Accepting new patients

Locations

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

2121 E Harmony Rd
Unit 170
Fort Collins, CO 80528
Phone (970) 493-6337

6767 29th St
Greeley, CO 80634
Phone (970) 652-2000

6767 29th St
Fl 1
Greeley, CO 80634
Phone (970) 652-2477

2500 Rocky Mountain Ave
Ste 2100
Loveland, CO 80538
Phone (970) 203-7153

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1104065218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD UNIT 170",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283413",
            "telephone_number": "970-493-6337",
            "fax_number": "970-493-3528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD UNIT 170",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80528",
            "telephone_number": "970-493-6337",
            "fax_number": "970-493-3528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERDELL",
        "first_name": "KATHERINE",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-12",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "PA.0005386",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA08433",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "013102",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.