Carolyn Suzanne Fearn, NP
Individual provider Active NPI Nurse Practitioner · Superior, CO
NPI 1104297357 · NPPES record last updated Jun 7, 2018
Key facts
- NPI
- 1104297357
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- APN.0991877-NP (CO)
- Practice address
- 3 Superior Dr Ste 100a
Superior, CO 80027 - Phone
- (303) 415-5255
- Fax
- (303) 415-5256
- NPI assigned
- Oct 14, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 34
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Boulder Community Health
Practice addresses (Care Compare)
6685 Gunpark Dr
Suite 110
Boulder, CO 80301-3343
Phone (303) 415-7599
Hospital & facility affiliations
- Boulder Community Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160115000738 | CO | Practitioner - Nurse Practitioner | 3870896350 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boulder Community Health | Current | Accepting new patients | |
| Boulder Community Health | Current |
Accepting new patients | |
| Boulder Community Health | Current |
Accepting new patients | |
| Boulder Community Health | Past | Accepting new patients | |
| Boulder Community Health | Past | Accepting new patients | |
| Boulder Community Health | Past |
Accepting new patients |
Locations
1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450
5450 Western Ave
Ste B
Boulder, CO 80301
4801 Riverbend Rd
Ste 200
Boulder, CO 80301
6685 Gunpark Dr
Ste 110
Boulder, CO 80301
Phone (303) 415-7599
2101 Ken Pratt Blvd
Ste 104C
Longmont, CO 80501
3 Superior Dr
Ste 100A
Superior, CO 80027
Phone (303) 415-5255
3 Superior Dr
Ste 100D
Superior, CO 80027
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APN.0991877-NP | CO | Yes |
Addresses
Primary practice location
3 Superior Dr Ste 100a
Superior, CO 80027
Mailing address
5450 Western Ave
Suite B
Boulder, CO 80301-2709
Phone (303) 415-5199
Other names
- Carolyn Suzanne Smith
NPI Registry JSON
{
"created_epoch": "1444780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528329600000",
"number": "1104297357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5450 WESTERN AVE",
"address_2": "SUITE B",
"city": "BOULDER",
"state": "CO",
"postal_code": "803012709",
"telephone_number": "303-415-5199",
"fax_number": "303-415-5198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 SUPERIOR DR STE 100A",
"city": "SUPERIOR",
"state": "CO",
"postal_code": "80027",
"telephone_number": "303-415-5255",
"fax_number": "303-415-5256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEARN",
"first_name": "CAROLYN",
"middle_name": "SUZANNE",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-14",
"last_updated": "2018-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CO",
"license": "APN.0991877-NP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CAROLYN",
"last_name": "SMITH",
"middle_name": "SUZANNE",
"credential": "NP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Superior, CO
- Deanna Jill Estes
- Elizabeth Evans
- Stacey Fair
- Tammy Faircloth
- Elizabeth Fanning
- Feel Better Physical Therapy, LLC
- Fields Counseling, LLC
- Pamela Fields
- Joshua Flanagan
- Flatirons Flexcare for Seniors LLC
All providers in Superior, CO · Nurse Practitioner in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.