Active NPI
Keith Eberhardt, PTA
- Physical Therapy Assistant
- Colorado Springs, CO
National Provider Identifier
1417324971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 10043
- Practice address
- 8540 Scarborough Dr
Suite 200
Colorado Springs, CO 80920-7502 - Phone
- (719) 630-7500
- NPI assigned
- Aug 31, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 10043 | OH | Primary |
Addresses
Primary practice location
8540 Scarborough Dr
Suite 200
Colorado Springs, CO 80920-7502
Mailing address
8540 Scarborough Dr
Suite 200
Colorado Springs, CO 80920-7502
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10043 | OH | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wsi | Past | Accepting new patients |
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.
-
- Nursing Care Agency
- Colorado Springs, CO
- NPI 1023317385
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440979200000",
"number": "1417324971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8540 SCARBOROUGH DR",
"address_2": "SUITE 200",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809207502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8540 SCARBOROUGH DR",
"address_2": "SUITE 200",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809207502",
"telephone_number": "719-630-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBERHARDT",
"first_name": "KEITH",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-31",
"last_updated": "2015-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OH",
"license": "10043",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.