NPIMap

Individual provider Active NPI

Amanda M Mixon, PA-C

  • Medical Physician Assistant
  • Longmont, CO
National Provider Identifier
1174795017
Registry record updated Feb 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.0002872 Issued in CO
Practice address
1715 Iron Horse Dr Ste 100
Longmont, CO 80501-9617
Phone
(720) 494-4700
Fax
(720) 494-4706
NPI assigned
Apr 1, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2020

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 PA.0002872 CO Primary

Addresses

Primary practice location

1715 Iron Horse Dr Ste 100
Longmont, CO 80501-9617

Mailing address

1715 Iron Horse Dr Ste 100
Longmont, CO 80501-9617
Phone (720) 494-4700

Other practice location 1

1840 Folsom St Ste 105
Boulder, CO 80302-5712
Phone (720) 494-4700

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
I20100521000358 CO Practitioner - Physician Assistant 5799814216 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

2121 E Harmony Rd
Fort Collins, CO 80528-3401

2500 Rocky Mountain Ave
Loveland, CO 80538-9004

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

  • Poudre Valley Hospital Hospital, Fort Collins, CO, CCN 060010
  • Medical Center of the Rockies Hospital, Loveland, CO, CCN 060119
  • Uchealth Greeley Hospital Hospital, Greeley, CO, CCN 060131
  • Regional West Medical Center Hospital, Scottsbluff, NE, CCN 280061
  • Ivinson Memorial Hospital Hospital, Laramie, WY, CCN 530025

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Oct 3, 2022 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Oct 3, 2022 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

2121 E Harmony Rd
Unit 360
Fort Collins, CO 80528
Phone (970) 267-9799

2121 E Harmony Rd
Unit 200
Fort Collins, CO 80528
Phone (970) 297-6550

2121 E Harmony Rd
Unit 230
Fort Collins, CO 80528
Phone (970) 266-8822

2121 E Harmony Rd
Unit 361
Fort Collins, CO 80528
Phone (970) 267-9799

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 2

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.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582761600000",
    "number": "1174795017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 IRON HORSE DR STE 100",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805019617",
            "telephone_number": "720-494-4700",
            "fax_number": "720-494-4706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 IRON HORSE DR STE 100",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805019617",
            "telephone_number": "720-494-4700",
            "fax_number": "720-494-4706"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1840 Folsom St Ste 105",
            "address_purpose": "LOCATION",
            "city": "Boulder",
            "state": "CO",
            "postal_code": "803025712",
            "country_code": "US",
            "telephone_number": "720-494-4700",
            "fax_number": "720-494-4706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIXON",
        "first_name": "AMANDA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-01",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0002872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.