Active NPI
Kathleen Donelan Fedack, M.D.
- Anesthesiology Physician
- Golden, CO
National Provider Identifier
1154312692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 31520
- Practice address
- 1819 Denver West Dr
Ste 200
Golden, CO 80401-3118 - Phone
- (303) 422-9438
- Fax
- (303) 422-9474
- NPI assigned
- Nov 3, 2005
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 31520 | CO | Primary |
Addresses
Primary practice location
1819 Denver West Dr
Ste 200
Golden, CO 80401-3118
Mailing address
PO Box 668
Arvada, CO 80001-0668
Phone (303) 422-9438
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01315209 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31520 | CO | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesia Associates of the Rockies LLC | Anesthesiology | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Anesthesiology Physician
- Lakewood, CO
- NPI 1962739003
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154312692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 668",
"city": "ARVADA",
"state": "CO",
"postal_code": "800010668",
"telephone_number": "303-422-9438",
"fax_number": "303-422-9474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1819 DENVER WEST DR",
"address_2": "STE 200",
"city": "GOLDEN",
"state": "CO",
"postal_code": "804013118",
"telephone_number": "303-422-9438",
"fax_number": "303-422-9474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDACK",
"first_name": "KATHLEEN",
"middle_name": "DONELAN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CO",
"license": "31520",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01315209",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Golden, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.