NPIMap

Individual provider Active NPI

Lisa M Whittaker, PA-C

  • Physician Assistant
  • Fort Collins, CO
National Provider Identifier
1235257346
Registry record updated Mar 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0003260 Issued in CO
Practice address
2121 E Harmony Rd
Suite 230
Fort Collins, CO 80528-3400
Phone
(970) 266-8822
Fax
(970) 266-8833
NPI assigned
Mar 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0003260 CO Primary
Physician Assistant 363A00000X MA-002706-L PA

Addresses

Primary practice location

2121 E Harmony Rd
Suite 230
Fort Collins, CO 80528-3400

Mailing address

2121 E Harmony Rd
Suite 230
Fort Collins, CO 80528-3400
Phone (970) 266-8822

Other identifiers 3

IdentifierTypeStateIssuer
133400000MedicaidWY
15228576MedicaidCO
P01142121OtherCOMEDICARE RAILROAD

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
I20120601000371 CO Practitioner - Physician Assistant 6002070091 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
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)

2450 S Peoria
Aurora, CO 80014-5475

2970 Arapahoe Rd
Lafayette, CO 80026-8054
Phone (303) 460-6010

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

Hospital & facility affiliations

  • Uchealth Pikes Peak Regional Hospital Hospital, Woodland Park, CO, CCN 061326
  • Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022
  • University of Colorado Hospital Authority Hospital, Aurora, CO, CCN 060024
  • Uchealth Highlands Ranch Hospital Hospital, Highlands Ranch, CO, CCN 060132

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0003260COMDPhysician Assistant
MA-002706-LPAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Mar 12, 2012 Accepting new patients

Locations

2450 S Peoria St
Ste 245
Aurora, CO 80014
Phone (303) 752-7732

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

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

4601 Corbett Dr
Fort Collins, CO 80528
Phone (970) 207-4800

2975 Ginnala Dr
Ste 120
Loveland, CO 80538
Phone (970) 624-5170

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

221 E 29th St
Ste 202
Loveland, CO 80538
Phone (970) 203-7050

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 47

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

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458518400000",
    "number": "1235257346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD",
            "address_2": "SUITE 230",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283400",
            "telephone_number": "970-266-8822",
            "fax_number": "970-266-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD",
            "address_2": "SUITE 230",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283400",
            "telephone_number": "970-266-8822",
            "fax_number": "970-266-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITTAKER",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2016-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0003260",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA-002706-L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133400000",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15228576",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P01142121",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.