NPIMap

Individual provider Active NPI

Kirsten Anne Revitte

  • Physician Assistant
  • Boulder, CO
National Provider Identifier
1124636568
Registry record updated Jul 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0006491 Issued in CO
Practice address
3434 47TH St Ste 200
Boulder, CO 80301-1817
Phone
(303) 444-8100
NPI assigned
Jul 22, 2020
Last updated
Jul 5, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2021

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 PA.0006491 CO Primary

Addresses

Primary practice location

3434 47TH St Ste 200
Boulder, CO 80301-1817

Mailing address

3434 47TH St Ste 200
Boulder, CO 80301-1817
Phone (303) 444-8100

Other practice location 1

3002 W Elizabeth St Unit 16B
Fort Collins, CO 80521-7526
Phone (303) 638-5859

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
I20210706000179 CO Practitioner - Physician Assistant 8224430822 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
K2 Dermatology LLCGroup PAC ID 9638547474, 6 clinicians

Practice addresses (Care Compare)

3434 47TH St
Suite 200
Boulder, CO 80301-1817
Phone (303) 444-8100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0006491COMDPhysician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1595376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625443200000",
    "number": "1124636568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 47TH ST STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011817",
            "telephone_number": "303-444-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 47TH ST STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011817",
            "telephone_number": "303-444-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3002 W Elizabeth St Unit 16B",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805217526",
            "country_code": "US",
            "telephone_number": "303-638-5859",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REVITTE",
        "first_name": "KIRSTEN",
        "middle_name": "ANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-22",
        "last_updated": "2021-07-05",
        "certification_date": "2021-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0006491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.