Michael Emile Guillette, PAC
Individual provider Active NPI Physician Assistant · Durango, CO
NPI 1174512115 · NPPES record last updated Oct 18, 2019
Key facts
- NPI
- 1174512115
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 889 (CO)
- Practice address
- 2577 Main Ave
Durango, CO 81301-5919 - Phone
- (970) 247-8382
- Fax
- (970) 259-4403
- NPI assigned
- Oct 20, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Durango Urgent Care LLC
Aztec Urgent Care, LLC
Practice addresses (Care Compare)
1942 E Main St
Cortez, CO 81321-3039
Phone (970) 516-5500
2577 Main Ave
Durango, CO 81301-5919
Phone (970) 247-8382
2930 E Main St
Farmington, NM 87402-7624
Phone (970) 505-2100
Hospital & facility affiliations
- Mercy Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CO, NM
- 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 |
|---|---|---|---|---|
| I20060227000404 | CO | Practitioner - Physician Assistant | 8820004989 | Reassigns benefits to 1 organization |
| I20130725000217 | NM | Practitioner - Physician Assistant | 8820004989 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 889 | CO | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Emergency Physicians, PC | Physician Assistant | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 889 | CO | Yes |
Addresses
Primary practice location
2577 Main Ave
Durango, CO 81301-5919
Mailing address
2577 Main Ave
Durango, CO 81301-5919
Phone (970) 247-8382
Other practice location 1
604 S Rio Grande Ave
Aztec, NM 87410-2260
Phone (505) 334-2664
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| L8806 | Medicaid | NM |
Other providers in Durango, CO
- Nicklas L Groskopf
- Richard Grossman
- Groundswell Acupuncture LLC
- Sarah Louise Gueli
- Elizabeth Guilfoyle
- Catherine Gustavson
- Arlene Marie Gutierrez
- Julia Gwyther
- Amy Hackmeier
- Isaac Eli Hall
All providers in Durango, CO · 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 Oct 18, 2019. 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.