NPIMap

Individual provider Active NPI

Mary Josephine Byron, PA-C

  • Surgical Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1366500779
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA-3218 Issued in CO
Practice address
525 N Foote Ave
Ste 302
Colorado Springs, CO 80909-4501
Phone
(719) 365-5445
Fax
(719) 365-5530
NPI assigned
Dec 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA-3218 CO Primary

Addresses

Primary practice location

525 N Foote Ave
Ste 302
Colorado Springs, CO 80909-4501

Mailing address

5450 Western Ave Ste B
Boulder, CO 80301-2709
Phone (303) 442-2395

Other identifiers 1

IdentifierTypeStateIssuer
83304371MedicaidCO

Other names 1

  • Miss Mary Josephine Santos Former name

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
I20110901000305 CO Practitioner - Physician Assistant 8426228305 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
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)

1400 E Boulder
Suite 2410 Pre Procedure Memorial
Colorado Springs, CO 80909-5533
Phone (719) 365-6525

1400 E Boulder St
Colorado Springs, CO 80909-5533

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

Hospital & facility affiliations

  • Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA-3218COMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Oct 1, 2012 Accepting new patients

Locations

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

1400 E Boulder St
Colorado Springs, CO 80909
Phone (719) 365-5120

1400 E Boulder St
Ste 700
Colorado Springs, CO 80909
Phone (719) 365-7172

525 Bob Peters Grv
Ste 302
Colorado Springs, CO 80909
Phone (719) 365-5445

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

Interoperability endpoints

  • Direct secure messaging: mbyron@bch.gwaydirect.com

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.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510185600000",
    "number": "1366500779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 WESTERN AVE STE B",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012709",
            "telephone_number": "303-442-2395",
            "fax_number": "303-442-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N FOOTE AVE",
            "address_2": "STE 302",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809094501",
            "telephone_number": "719-365-5445",
            "fax_number": "719-365-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BYRON",
        "first_name": "MARY",
        "middle_name": "JOSEPHINE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2017-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "PA-3218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "83304371",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "SANTOS",
            "middle_name": "JOSEPHINE",
            "prefix": "MISS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.