Active NPI
Antonio J Wood, M.D.
- Psychiatry Physician
- Boulder, CO
National Provider Identifier
1124106810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 21616
- Practice address
- 3450 Penrose PL
Suite 250
Boulder, CO 80301-1828 - Phone
- (303) 440-3411
- NPI assigned
- Nov 1, 2006
- Last updated
- Jul 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 21616 | CO | Primary |
Addresses
Primary practice location
3450 Penrose PL
Suite 250
Boulder, CO 80301-1828
Mailing address
3450 Penrose PL
Suite 250
Boulder, CO 80301-1828
Phone (303) 440-3411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 15, 2016 through Jan 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21616 | CO | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184889600000",
"number": "1124106810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3450 PENROSE PL",
"address_2": "SUITE 250",
"city": "BOULDER",
"state": "CO",
"postal_code": "803011828",
"telephone_number": "303-440-3411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3450 PENROSE PL",
"address_2": "SUITE 250",
"city": "BOULDER",
"state": "CO",
"postal_code": "803011828",
"telephone_number": "303-440-3411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOD",
"first_name": "ANTONIO",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CO",
"license": "21616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.