Natalie Mannon Ibrahim, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0004763 Issued in CO

Practice address

777 29TH St Ste 301
Boulder, CO 80303-2316

Phone

(303) 440-8243

Fax

(303) 440-0292

NPI assigned

Feb 23, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Natalie Marie Mannon Former name

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Flatirons Spine & Joint Health LLC

  dba Boulder Valley Family Practice

  • Medical Specialty Clinic/Center
  • Boulder, CO
  • NPI 1447318225
  NPD (past)
• New West Physicians Inc

  • Internal Medicine Physician
  • Golden, CO
  • NPI 1427010859

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1487808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701993600000",
    "number": "1285173203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 29TH ST STE 301",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803032316",
            "telephone_number": "303-440-8243",
            "fax_number": "303-440-0292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 29TH ST STE 301",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803032316",
            "telephone_number": "303-440-8243",
            "fax_number": "303-440-0292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "NATALIE",
        "middle_name": "MANNON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-23",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "0004763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NATALIE",
            "last_name": "MANNON",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kent Hutchison, PHD
• Leslie Hveem
• Kristina S Hyde, RN/APN
• Pamela Jeane Hyink, SLP
• Ian M Kott DDS PC (Kott Pediatric Dentistry)
• Clayton Ickes, LSW
• Icn PLLC (Institute for Clinical Neurosciences)
• Ilya Igolnikov, MD
• Jana Ikeda, D.D.S.
• Eva Ikonen

• Physician Assistant in Boulder, CO
• Providers in Boulder, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.