NPIMap

Individual provider Active NPI

Gerald Steele Kidd III, PA-C

  • Medical Physician Assistant
  • Lakewood, CO
National Provider Identifier
1265552210
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.0004075 Issued in CO
Practice address
13952 Denver West Pkwy Ste 100
Lakewood, CO 80401-3141
Phone
(303) 604-5000
Fax
(720) 890-0364
NPI assigned
Mar 30, 2007
Last updated
Apr 17, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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.0004075 CO Primary

Addresses

Primary practice location

13952 Denver West Pkwy Ste 100
Lakewood, CO 80401-3141

Mailing address

382 S Arthur Ave
Louisville, CO 80027-3094
Phone (303) 604-5000

Other identifiers 1

IdentifierTypeStateIssuer
90056868MedicaidCO

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
I20141215001693 CO Practitioner - Physician Assistant 4789603812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1000 W S Boulder Rd
Suite 200
Lafayette, CO 80026-2088
Phone (303) 604-5000

1830 N Franklin St
Denver, CO 80218-1128
Phone (303) 604-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0004075COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Valley Gastroenterology Inc. CurrentSince Mar 1, 2020 Accepting new patients
Boulder Valley Gastroenterology Inc. CurrentSince Mar 1, 2020 Accepting new patients
Boulder Valley Gastroenterology Inc. Past Accepting new patients
Optumcare Colorado ASC, LLC Past Accepting new patients
Digestive Disease Endoscopy Center Past Accepting new patients

Locations

1755 48th St
Ste 100
Boulder, CO 80301
Phone (720) 932-7714

16677 Lowell Blvd
Ste 200
Broomfield, CO 80023

1830 N Franklin St
Ste 220
Denver, CO 80218

1960 N Ogden St
Ste 210
Denver, CO 80218
Phone (303) 832-9277

1000 W South Boulder Rd
Ste 200
Lafayette, CO 80026
Phone (720) 932-7719

13952 Denver West Pkwy
Ste 100
Lakewood, CO 80401
Phone (303) 271-1112

1551 Professional Ln
Unit 290
Longmont, CO 80501

382 S Arthur Ave
Louisville, CO 80027

382 S Arthur Ave
Unit 100
Louisville, CO 80027

11900 Grant St
Ste 360
Northglenn, CO 80233
Phone (817) 306-5630

Organizations & group practices 5

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1265552210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "382 S ARTHUR AVE",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800273094",
            "telephone_number": "303-604-5000",
            "fax_number": "720-890-0364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13952 DENVER WEST PKWY STE 100",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "804013141",
            "telephone_number": "303-604-5000",
            "fax_number": "720-890-0364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDD",
        "first_name": "GERALD",
        "middle_name": "STEELE",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0004075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90056868",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.