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Individual provider Active NPI

Victoria M Evelyn, PA

  • Medical Physician Assistant
  • Boulder, CO
National Provider Identifier
1114332020
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.0008275 Issued in CO
Practice address
1755 48TH St Ste 100
Boulder, CO 80301-2712
Phone
(303) 604-5000
NPI assigned
Jun 30, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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 0110004619 VA
Medical Physician Assistant 363AM0700X PA.0008275 CO Primary

Addresses

Primary practice location

1755 48TH St Ste 100
Boulder, CO 80301-2712

Mailing address

4092 Foxwood Dr
Virginia Beach, VA 23462-5225
Phone (757) 467-4200

Other practice location 1

4092 Foxwood Dr
Virginia Beach, VA 23462-5225
Phone (757) 467-4200

Other names 1

  • Victoria M Bock Former name

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
I20240401000780 CO Practitioner - Physician Assistant 3173815099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boulder Valley Gastroenterology Inc.Group PAC ID 4688577174, 33 clinicians

Practice addresses (Care Compare)

1000 W S Boulder Rd
Suite 200
Lafayette, CO 80026-2088
Phone (303) 604-5000

1830 N Franklin St
Denver, CO 80218-1128
Phone (303) 604-5000

Hospital & facility affiliations

  • Boulder Community Health Hospital, Boulder, CO, CCN 060027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0110004619VAMDMedical Physician Assistant
PA.0008275COMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Valley Gastroenterology Inc. CurrentSince Apr 1, 2024 Accepting new patients

Locations

1755 48th St
Ste 100
Boulder, CO 80301
Phone (720) 932-7714

1830 N Franklin St
Ste 220
Denver, CO 80218

1000 W South Boulder Rd
Ste 200
Lafayette, CO 80026
Phone (303) 604-4664

382 S Arthur Ave
Unit 100
Louisville, CO 80027

382 S Arthur Ave
Louisville, CO 80027

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 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1114332020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4092 FOXWOOD DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234625225",
            "telephone_number": "757-467-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 48TH ST STE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012712",
            "telephone_number": "303-604-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4092 Foxwood Dr",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234625225",
            "country_code": "US",
            "telephone_number": "757-467-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVELYN",
        "first_name": "VICTORIA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-30",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110004619",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0008275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "BOCK",
            "middle_name": "M",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.