NPIMap

Individual provider Active NPI

Melissa Ann Berghoff, PA-C

  • Physician Assistant
  • Boulder, CO
National Provider Identifier
1376786764
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0002713 Issued in CO
Practice address
2995 Baseline Rd
Suite 210
Boulder, CO 80303-2318
Phone
(303) 443-2544
Fax
(303) 443-6476
NPI assigned
Apr 14, 2009
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
Physician Assistant 363A00000X PA.0002713 CO Primary

Addresses

Primary practice location

2995 Baseline Rd
Suite 210
Boulder, CO 80303-2318

Mailing address

5450 Western Ave
Suite B
Boulder, CO 80301-2709
Phone (303) 415-8900

Other identifiers 1

IdentifierTypeStateIssuer
91921791MedicaidCO

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
I20091023000583 CO Practitioner - Physician Assistant 1658418678 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

1645 Broadway
Boulder, CO 80302-6218
Phone (303) 415-8900

1755 48TH St
Suite 200
Boulder, CO 80301-2712
Phone (303) 415-7450

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0002713COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Dec 1, 2013 Accepting new patients
Boulder Community Health CurrentSince Dec 1, 2013 Accepting new patients
Boulder Community Health PastSince Aug 1, 2019 Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

2995 Baseline Rd
Ste 210
Boulder, CO 80303
Phone (303) 415-8900

1645 Broadway
Boulder, CO 80302
Phone (303) 415-8900

5450 Western Ave
Ste B
Boulder, CO 80301

1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450

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 and National Provider Directory roles.

Hospital & facility affiliations 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510185600000",
    "number": "1376786764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 WESTERN AVE",
            "address_2": "SUITE B",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012709",
            "telephone_number": "303-415-8900",
            "fax_number": "303-443-6476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2995 BASELINE RD",
            "address_2": "SUITE 210",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803032318",
            "telephone_number": "303-443-2544",
            "fax_number": "303-443-6476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGHOFF",
        "first_name": "MELISSA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-14",
        "last_updated": "2017-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0002713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "91921791",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.