Active NPI
Michael S Walsh, PA-C
- Medical Physician Assistant
- Pueblo, CO
National Provider Identifier
1164584686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 1662
- Practice address
- 3116 N. Elizabeth
Pueblo, CO 81008 - Phone
- (719) 542-7222
- Fax
- (719) 542-5034
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1662 | CO | Primary |
Addresses
Primary practice location
3116 N. Elizabeth
Pueblo, CO 81008
Mailing address
3116 N Elizabeth St
Pueblo, CO 81008-1163
Phone (719) 542-7222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130517000191 | CO | Order and Referring Only - Physician Assistant | 3072750769 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1662 | CO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362441600000",
"number": "1164584686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3116 N ELIZABETH ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081163",
"telephone_number": "719-542-7222",
"fax_number": "719-542-5034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3116 N. ELIZABETH",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81008",
"telephone_number": "719-542-7222",
"fax_number": "719-542-5034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALSH",
"first_name": "MICHAEL",
"middle_name": "S",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-14",
"last_updated": "2013-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CO",
"license": "1662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.