Mark Baratta, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9107209 Issued in FL

Practice address

3455 Lutheran Pkwy
Suite 280
Wheat Ridge, CO 80033-6028

Phone

(303) 403-7300

Fax

(303) 403-7310

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Park Slope Physician Services PC

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1013018324
  NPD (past)

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558310400000",
    "number": "1174742944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 LUTHERAN PKWY",
            "address_2": "SUITE 280",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336028",
            "telephone_number": "303-403-7300",
            "fax_number": "303-403-7310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 LUTHERAN PKWY",
            "address_2": "SUITE 280",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336028",
            "telephone_number": "303-403-7300",
            "fax_number": "303-403-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARATTA",
        "first_name": "MARK",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2019-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "0064591",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9107209",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA-3186",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25258231",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adrian Balota
• Ana Balzar, LCSW
• Anisa Banks
• Shelby Salley Banks, FNP
• Anna Bannigan, PT
• Kelly J Barbato, PA-C
• Belle Barber
• Christopher Michael Bardorf, M.D.
• Melissa Barela
• Taylor Barela

• All providers in Wheat Ridge, CO
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.