NPIMap

Individual provider Active NPI

Dawn M Malsom, PAC

  • Physician Assistant
  • Longmont, CO
National Provider Identifier
1275664047
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1664 Issued in CO
Practice address
1750 E Ken Pratt Blvd
Longmont, CO 80504-5311
Phone
(720) 718-7000
Fax
(720) 718-0973
NPI assigned
Mar 7, 2007
Last updated
Nov 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1664 CO Primary

Addresses

Primary practice location

1750 E Ken Pratt Blvd
Longmont, CO 80504-5311

Mailing address

1750 E Ken Pratt Blvd
Longmont, CO 80504-5311
Phone (720) 718-7000

Other practice location 1

11820 Destination Dr
Broomfield, CO 80021-2518
Phone (303) 464-4940

Other identifiers 1

IdentifierTypeStateIssuer
07175043MedicaidCO

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
I20100813000504 CO Practitioner - Physician Assistant 3072647957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1750 E Ken Pratt Blvd
Uchealth
Longmont, CO 80504-5311
Phone (970) 237-7848

1760 E Ken Pratt Blvd
Longmont, CO 80504-5311

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

6767 29TH St
Greeley, CO 80634-5474
Phone (970) 224-3636

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1664COMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Sep 14, 2020 Accepting new patients
Colorado Urgent Care PLLC PastSince Aug 2, 2020 Accepting new patients

Locations

11820 Destination Dr
Broomfield, CO 80021
Phone (303) 460-6000

6767 29th St
Greeley, CO 80634
Phone (970) 652-2000

6767 29th St
Fl 2
Greeley, CO 80634
Phone (970) 652-2433

1750 E Ken Pratt Blvd
Longmont, CO 80504
Phone (720) 718-7000

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

Organizations & group practices 3

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763596800000",
    "number": "1275664047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 E KEN PRATT BLVD",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805045311",
            "telephone_number": "720-718-7000",
            "fax_number": "720-718-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E KEN PRATT BLVD",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805045311",
            "telephone_number": "720-718-7000",
            "fax_number": "720-718-0973"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11820 Destination Dr",
            "address_purpose": "LOCATION",
            "city": "Broomfield",
            "state": "CO",
            "postal_code": "800212518",
            "country_code": "US",
            "telephone_number": "303-464-4940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALSOM",
        "first_name": "DAWN",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "1664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07175043",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.