Individual provider Active NPI

Maria Dee Ibach, PA

  • Physician Assistant
  • Lone Tree, CO
National Provider Identifier
1346296795
Registry record updated May 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0001193 Issued in CO
Practice address
10240 Park Meadows Dr
Lone Tree, CO 80124-5425
Phone
(303) 338-3800
NPI assigned
May 26, 2006
Last updated
May 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 103988 NC
Physician Assistant 363A00000X PA.0001193 CO Primary

Addresses

Primary practice location

10240 Park Meadows Dr
Lone Tree, CO 80124-5425

Mailing address

10350 E Dakota Ave
Denver, CO 80247-1314

Other practice location 1

6271 Saint Augustine Rd Ste 1
Jacksonville, FL 32217-2555
Phone (904) 633-0460

Other identifiers 1

IdentifierTypeStateIssuer
007856100MedicaidFL

Other names 1

  • Maria D Latzka Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, CO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20130131000476 FL Practitioner - Physician Assistant 4486808342 Reassigns benefits to 1 organization
I20260610001667 CO Practitioner - Physician Assistant 4486808342 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Colorado School of Medicine, Denver, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10350 E Dakota Ave
Denver, CO 80247-1314

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1193COMDClinical Psychologist
PA.0001193COMDPhysician Assistant
103988NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians Inc CurrentSince Jan 21, 2013 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Jan 21, 2013 Accepting new patients
Stepping Stones Pediatrics, PLLC Past Accepting new patients
Raleigh Durham Medical Group, PA Past Accepting new patients
Colorado Permanente Medical Group, P.C. Past Accepting new patients

Locations

1443 San Marco Blvd
Jacksonville, FL 32207
Phone (904) 633-4110

6271 Saint Augustine Rd
Ste 1
Jacksonville, FL 32217
Phone (904) 633-0460

Interoperability endpoints

  • Direct secure messaging: mibach122433@direct.shands.ufl.edu

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779408000000",
    "number": "1346296795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10350 E DAKOTA AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802471314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10240 PARK MEADOWS DR",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801245425",
            "telephone_number": "303-338-3800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6271 Saint Augustine Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322172555",
            "country_code": "US",
            "telephone_number": "904-633-0460",
            "fax_number": "904-633-0461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBACH",
        "first_name": "MARIA",
        "middle_name": "DEE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-26",
        "last_updated": "2026-05-22",
        "certification_date": "2026-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103988",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0001193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007856100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10240 Park Meadows Dr",
            "city": "Lone Tree",
            "state": "CO",
            "country_code": "US",
            "postal_code": "801245425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "LATZKA",
            "middle_name": "D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lone Tree, CO

Sources for this page

Verify at the official NPI Registry.