Individual provider Active NPI

Annabel Bavage, PT

  • Orthopedic Physical Therapist
  • Louisville, CO
National Provider Identifier
1215455290
Registry record updated Aug 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
0014948 Issued in CO
Practice address
315 W South Boulder Rd Ste 100
Louisville, CO 80027-1157
Phone
(303) 666-4151
NPI assigned
Aug 30, 2017
Last updated
Aug 30, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 0014948 CO Primary

Addresses

Primary practice location

315 W South Boulder Rd Ste 100
Louisville, CO 80027-1157

Mailing address

315 W South Boulder Rd Ste 100
Louisville, CO 80027-1157
Phone (763) 670-6319

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171023002423 CO Practitioner - Physical Therapist in Private Practice 2769758556 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Coal Creek Physical Therapy, LLC Physical Therapist CurrentSince Aug 29, 2017 Accepting new patients
Coal Creek Diagnostics, LLC PastSince Aug 29, 2017 Accepting new patients

Locations

315 W South Boulder Rd
Ste 100
Louisville, CO 80027
Phone (303) 666-4151

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1504051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504051200000",
    "number": "1215455290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W SOUTH BOULDER RD STE 100",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800271157",
            "telephone_number": "763-670-6319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W SOUTH BOULDER RD STE 100",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800271157",
            "telephone_number": "303-666-4151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAVAGE",
        "first_name": "ANNABEL",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-30",
        "last_updated": "2017-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CO",
            "license": "0014948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.