Individual provider Active NPI

Laura Fagundes, PA-C

  • Physician Assistant
  • Denver, CO
National Provider Identifier
1104140607
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2977 Issued in CO
Practice address
3825 N Lafayette St
Denver, CO 80205-3316
Phone
(303) 500-1518
Fax
(720) 598-0440
NPI assigned
Mar 26, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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 2977 CO Primary

Addresses

Primary practice location

3825 N Lafayette St
Denver, CO 80205-3316

Mailing address

1100 Federal Blvd.
Westside Pediatric Clinic
Denver, CO 80204
Phone (303) 436-4200

Other practice location 1

1100 Federal Blvd.
Westside Pediatric Clinic
Denver, CO 80204
Phone (303) 436-4200 ext. 64304

Other identifiers 1

IdentifierTypeStateIssuer
30128765MedicaidCO

Other names 1

  • Laura Fagundes Klein Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lfagundes7775@direct.dhha.org Health Information Exchange (HIE)

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
I20100609000818 CO Practitioner - Physician Assistant 8921138405 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2977COMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Surgical Associates, PC Past Accepting new patients
Denver Health and Hospital Authority Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lfagundes7775@direct.dhha.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1269561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1104140607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 FEDERAL BLVD.",
            "address_2": "WESTSIDE PEDIATRIC CLINIC",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "80204",
            "telephone_number": "303-436-4200",
            "fax_number": "303-436-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3825 N LAFAYETTE ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802053316",
            "telephone_number": "303-500-1518",
            "fax_number": "720-598-0440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Federal Blvd.",
            "address_2": "Westside Pediatric Clinic",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "80204",
            "country_code": "US",
            "telephone_number": "303-436-4200 x64304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAGUNDES",
        "first_name": "LAURA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-26",
        "last_updated": "2023-08-22",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "2977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30128765",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lfagundes7775@direct.dhha.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "777 Bannock St",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802044597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "KLEIN",
            "middle_name": "FAGUNDES",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.