Individual provider Active NPI

Carlos Eduardo Fuenmayor, CSA

  • Medical Physician Assistant
  • Aurora, CO
National Provider Identifier
1316286008
Registry record updated Jan 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
13-115 Issued in CO
Practice address
1673 S Flanders Way
Aurora, CO 80017-5509
Phone
(720) 748-2888
NPI assigned
Jan 31, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 31, 2013

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 13-115 CO Primary

Addresses

Primary practice location

1673 S Flanders Way
Aurora, CO 80017-5509

Mailing address

22154 E Euclid Dr
Aurora, CO 80016-2359
Phone (720) 377-4160

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
13-115COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Physician Surgical Assistance Past Accepting new patients
Colorado Physician Surgical Asst Inc Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1359590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359590400000",
    "number": "1316286008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22154 E EUCLID DR",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800162359",
            "telephone_number": "720-377-4160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1673 S FLANDERS WAY",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800175509",
            "telephone_number": "720-748-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUENMAYOR",
        "first_name": "CARLOS",
        "middle_name": "EDUARDO",
        "credential": "CSA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-31",
        "last_updated": "2013-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "13-115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.