Individual provider Active NPI

Thomas R Avonda, MD

  • Family Medicine Physician
  • Strasburg, CO
National Provider Identifier
1407920101
Registry record updated Apr 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR.0055609 Issued in CO
Practice address
55981 E Colfax Ave
Strasburg, CO 80136-8014
Phone
(719) 632-5700
Fax
(719) 344-7817
NPI assigned
Nov 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DR.0055609 CO Primary
Family Medicine Physician 207Q00000X 41571 TN

Addresses

Primary practice location

55981 E Colfax Ave
Strasburg, CO 80136-8014

Mailing address

3205 N Academy Blvd
Suite 130
Colorado Springs, CO 80917-5147
Phone (719) 632-5700

Other identifiers 1

IdentifierTypeStateIssuer
31025595MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070215000348 TN Practitioner - Family Practice 0941202295 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Education Assistance Corporation Family Medicine CurrentSince Jun 15, 2008 Accepting new patients

Locations

222 E Main St
Johnson City, TN 37604
Phone (423) 433-6200

917 W Walnut St
Johnson City, TN 37604
Phone (423) 439-6464

400 E State of Franklin Rd
Johnson City, TN 37601
Phone (423) 433-6200

Organizations & group practices 1

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": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491177600000",
    "number": "1407920101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 N ACADEMY BLVD",
            "address_2": "SUITE 130",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175147",
            "telephone_number": "719-632-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55981 E COLFAX AVE",
            "city": "STRASBURG",
            "state": "CO",
            "postal_code": "801368014",
            "telephone_number": "719-632-5700",
            "fax_number": "719-344-7817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVONDA",
        "first_name": "THOMAS",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2017-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0055609",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "41571",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31025595",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Strasburg, CO

Sources for this page

Verify at the official NPI Registry.