Active NPI
Timothy William Stewart, PA
- Specialist
- Broomfield, CO
National Provider Identifier
1235386798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1543
- Practice address
- 340 E 1St Ave
Duite 307
Broomfield, CO 80020-2401 - Phone
- (303) 428-6089
- Fax
- (303) 412-2141
- NPI assigned
- Aug 26, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1543 | CO | Primary |
Addresses
Primary practice location
340 E 1St Ave
Duite 307
Broomfield, CO 80020-2401
Mailing address
340 E 1St Ave
Suite 307
Broomfield, CO 80020-2401
Phone (303) 428-6089
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235386798 | Other | NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1543 | CO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233619200000",
"number": "1235386798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 E 1ST AVE",
"address_2": "SUITE 307",
"city": "BROOMFIELD",
"state": "CO",
"postal_code": "800202401",
"telephone_number": "303-428-6089",
"fax_number": "303-412-2141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 E 1ST AVE",
"address_2": "DUITE 307",
"city": "BROOMFIELD",
"state": "CO",
"postal_code": "800202401",
"telephone_number": "303-428-6089",
"fax_number": "303-412-2141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEWART",
"first_name": "TIMOTHY",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-26",
"last_updated": "2009-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CO",
"license": "1543",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1235386798",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Broomfield, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.