Individual provider Active NPI

Susan Grace Stanton, P.A.-C.

  • Physician Assistant
  • Loveland, CO
National Provider Identifier
1356538177
Registry record updated Jan 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0002498 Issued in CO
Practice address
2500 Rocky Mountain Ave
Suite 100
Loveland, CO 80538-9004
Phone
(970) 624-1800
Fax
(970) 624-1891
NPI assigned
Sep 25, 2007
Last updated
Jan 9, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2017

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 PA.0002498 CO Primary

Addresses

Primary practice location

2500 Rocky Mountain Ave
Suite 100
Loveland, CO 80538-9004

Mailing address

2500 Rocky Mountain Ave
Suite 100
Loveland, CO 80538-9004
Phone (970) 624-1800

Other identifiers 3

IdentifierTypeStateIssuer
134090500MedicaidWY
P00757962OtherCORR MEDICARE
69054371MedicaidCO

Other names 1

  • Susan Grace Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080214000104 CO Practitioner - Physician Assistant 9537242516 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
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)

2500 Rocky Mountain Ave
Loveland, CO 80538-9004

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0002498COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Health Care Inc. CurrentSince Nov 3, 2008 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Sep 1, 2010 Accepting new patients
Poudre Valley Health Care Inc CurrentSince Nov 3, 2008 Accepting new patients
Surgical Specialists Past Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

1107 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 493-7442

4601 Corbett Dr
Fort Collins, CO 80528
Phone (970) 207-4800

2121 E Harmony Rd
Unit 100
Fort Collins, CO 80528
Phone (970) 663-3107

2315 E Harmony Rd
Ste 200
Fort Collins, CO 80528

1024 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 495-7000

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

2500 Rocky Mountain Ave
Ste 100
Loveland, CO 80538
Phone (970) 624-1800

2500 Rocky Mountain Ave
Ste 360
Loveland, CO 80538
Phone (970) 221-5878

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 3

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": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483920000000",
    "number": "1356538177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 ROCKY MOUNTAIN AVE",
            "address_2": "SUITE 100",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389004",
            "telephone_number": "970-624-1800",
            "fax_number": "970-624-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 ROCKY MOUNTAIN AVE",
            "address_2": "SUITE 100",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389004",
            "telephone_number": "970-624-1800",
            "fax_number": "970-624-1891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANTON",
        "first_name": "SUSAN",
        "middle_name": "GRACE",
        "name_prefix": "Ms.",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-25",
        "last_updated": "2017-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0002498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134090500",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00757962",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "69054371",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "GRACE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.