NPIMap

Individual provider Active NPI

Julie Ann Caballero, PA-C, MPAS

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1154671295
Registry record updated Feb 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0004164 Issued in CO
Practice address
1400 E Boulder St Ste 600
Colorado Springs, CO 80909-5533
Phone
(719) 364-6487
NPI assigned
Sep 17, 2012
Last updated
Feb 7, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 99053793A IN
Physician Assistant 363A00000X PA.0004164 CO Primary

Addresses

Primary practice location

1400 E Boulder St Ste 600
Colorado Springs, CO 80909-5533

Mailing address

2222 N Nevada Ave
Suite 5010
Colorado Springs, CO 80907-6819
Phone (719) 776-6700

Other practice location 1

2222 N Nevada Ave
Suite 5010
Colorado Springs, CO 80907-6819
Phone (719) 776-6700

Other practice location 2

4110 Briargate Pkwy Ste 140
Colorado Springs, CO 80920-7836
Phone (719) 364-8346

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
I20150127002215 CO Practitioner - Physician Assistant 5890947501 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1400 E Boulder
Suite 2410 Pre Procedure Memorial
Colorado Springs, CO 80909-5533
Phone (719) 365-6525

1400 E Boulder St
Colorado Springs, CO 80909-5533

16222 W US Hwy 24
Suite 200 Uchealth Family Medicine Woodla
Woodland Park, CO 80863-8763
Phone (719) 686-0878

16222 W US Hwy 24 220
Uchmg Woodland Park Outreach
Woodland Park, CO 80863-8763
Phone (719) 630-1006

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
99053793AINMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Aug 27, 2018 Accepting new patients

Locations

1400 E Boulder St
Ste 600
Colorado Springs, CO 80909
Phone (719) 364-6487

4110 Briargate Pkwy
Ste 140
Colorado Springs, CO 80920
Phone (719) 365-7300

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

16222 W US Highway 24
Ste 220
Woodland Park, CO 80863
Phone (719) 365-7300

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581033600000",
    "number": "1154671295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 N NEVADA AVE",
            "address_2": "SUITE 5010",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076819",
            "telephone_number": "719-776-6700",
            "fax_number": "719-776-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E BOULDER ST STE 600",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095533",
            "telephone_number": "719-364-6487"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2222 N Nevada Ave",
            "address_2": "Suite 5010",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809076819",
            "country_code": "US",
            "telephone_number": "719-776-6700",
            "fax_number": "719-776-6780",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4110 Briargate Pkwy Ste 140",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809207836",
            "country_code": "US",
            "telephone_number": "719-364-8346",
            "fax_number": "719-364-8347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CABALLERO",
        "first_name": "JULIE",
        "middle_name": "ANN",
        "credential": "PA-C, MPAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-17",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "99053793A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.