NPIMap

Individual provider Active NPI

Moni Banerjee, PA

  • Medical Physician Assistant
  • Boulder, CO
National Provider Identifier
1164551727
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2169 Issued in CO
Practice address
4743 Arapahoe Ave
Suite 201
Boulder, CO 80303-1113
Phone
(303) 442-2395
Fax
(303) 442-1073
NPI assigned
Mar 2, 2007
Last updated
Nov 9, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2169 CO Primary

Addresses

Primary practice location

4743 Arapahoe Ave
Suite 201
Boulder, CO 80303-1113

Mailing address

5450 Western Ave
Suite B
Boulder, CO 80301-2709
Phone (303) 442-2395

Other identifiers 1

IdentifierTypeStateIssuer
34388800MedicaidCO

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
I20070607000555 CO Practitioner - Physician Assistant 3678671021 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

1755 48TH St
Suite 200
Boulder, CO 80301-2712
Phone (303) 415-7450

4743 Arapahoe Ave
Boulder, CO 80303-1128

4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 415-7610

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Oct 2, 2011 Accepting new patients
Boulder Community Health CurrentSince Oct 2, 2011 Accepting new patients
Rocky Mountain Cardiology Past Accepting new patients
Juli Renee Booton Past Accepting new patients
Boulder Community Health Past Accepting new patients
Boulder Community Health PastSince Aug 1, 2019 Accepting new patients

Locations

1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450

2505 4th St
Boulder, CO 80304
Phone (303) 441-5237

4743 Arapahoe Ave
Ste 201
Boulder, CO 80303

5450 Western Ave
Ste B
Boulder, CO 80301

2101 Ken Pratt Blvd
Ste 104B
Longmont, CO 80501

Organizations & group practices 7

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": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510185600000",
    "number": "1164551727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 WESTERN AVE",
            "address_2": "SUITE B",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012709",
            "telephone_number": "303-442-2395",
            "fax_number": "303-442-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4743 ARAPAHOE AVE",
            "address_2": "SUITE 201",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031113",
            "telephone_number": "303-442-2395",
            "fax_number": "303-442-1073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANERJEE",
        "first_name": "MONI",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-02",
        "last_updated": "2017-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "2169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34388800",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.