Individual provider Active NPI

Michael Banwart, PSYD

  • Clinical Psychologist
  • Aurora, CO
National Provider Identifier
1104493162
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY.0006562 Issued in CO
Practice address
1504 Galena St
Aurora, CO 80010-2219
Phone
(303) 617-2300
NPI assigned
Jun 8, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY.0006562 CO Primary

Addresses

Primary practice location

1504 Galena St
Aurora, CO 80010-2219

Mailing address

1290 Chambers Rd
Aurora, CO 80011-7117
Phone (303) 617-2300

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241101000121 CO Practitioner - Clinical Psychologist 8628501426 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Group practices
Aurora Comprehensive Community Mental Health CenterGroup PAC ID 9335047778, 102 clinicians

Practice addresses (Care Compare)

1504 Galena St
Aurora, CO 80010-2219
Phone (303) 617-2300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Comprehensive Community Mental Health Center CurrentSince Oct 16, 2024 Accepting new patients
Aurora Comprehensive Community Mental Health Center, Inc Current Accepting new patients
Aurora Comprehensive Community Mental Health Center, Inc CurrentSince Oct 16, 2024 Accepting new patients
Aurora Comprehensive Community Mental Health Center Inc Past Accepting new patients

Locations

14301 E Hampden Ave
Aurora, CO 80014
Phone (303) 617-2600

1290 Chambers Rd
Aurora, CO 80011
Phone (303) 617-2715

791 Chambers Rd
Fl 5
Aurora, CO 80011

1504 Galena St
Aurora, CO 80010
Phone (303) 617-2498

791 Chambers Rd
Aurora, CO 80011
Phone (303) 923-2919

Organizations & group practices 4

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": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1104493162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 CHAMBERS RD",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800117117",
            "telephone_number": "303-617-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 GALENA ST",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800102219",
            "telephone_number": "303-617-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANWART",
        "first_name": "MICHAEL",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-08",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "PSY.0006562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.