Moni Banerjee, PA
Individual provider Active NPI Medical Physician Assistant · Boulder, CO
NPI 1164551727 · NPPES record last updated Nov 9, 2017
Key facts
- NPI
- 1164551727
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 2169 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 34
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Boulder Community Health
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
- Boulder Community Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070607000555 | CO | Practitioner - Physician Assistant | 3678671021 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boulder Community Health | Current |
Accepting new patients | |
| Boulder Community Health | Current |
Accepting new patients | |
| Rocky Mountain Cardiology | Past | Accepting new patients | |
| Boulder Community Health | Past |
Accepting new patients | |
| Boulder Community Health | Past | Accepting new patients | |
| Juli Renee Booton | Past | Accepting new patients |
Locations
2505 4th St
Boulder, CO 80304
Phone (303) 441-5237
5450 Western Ave
Ste B
Boulder, CO 80301
1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450
4743 Arapahoe Ave
Ste 201
Boulder, CO 80303
2101 Ken Pratt Blvd
Ste 104B
Longmont, CO 80501
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 2169 | CO | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34388800 | Medicaid | CO |
NPI Registry JSON
{
"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
- Annie Bamaw
- Marnessa J Bambara
- Jennifer Ban
- Anita P Bancroft
- Polly Banerjee Gallagher
- Lori Banghart
- Mo Bankey
- Adrian Banks
- Heather S Banks
- Aviva Naomi Bannerman
All providers in Boulder, CO · Medical Physician Assistant in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.