NPIMap

Individual provider Active NPI

Kelly Woodside Kolar, PA-C

  • Physician Assistant
  • Boulder, CO
National Provider Identifier
1427550300
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0005209 Issued in CO
Practice address
1645 Broadway
Boulder, CO 80302-6218
Phone
(303) 415-8900
Fax
(303) 443-6476
NPI assigned
Mar 6, 2018
Last updated
Sep 29, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA750 WY
Physician Assistant 363A00000X PA.0005209 CO Primary

Addresses

Primary practice location

1645 Broadway
Boulder, CO 80302-6218

Mailing address

PO Box 9049
Boulder, CO 80301-9049
Phone (303) 415-8900

Other practice location 1

2575 Spruce St
Boulder, CO 80302-3806
Phone (303) 415-3875

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
I20210107000629 CO Practitioner - Physician Assistant 6800150962 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
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

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Jan 1, 2021 Accepting new patients
Boulder Community Health CurrentSince Jan 1, 2021 Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

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

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

2575 Spruce St
Boulder, CO 80302
Phone (303) 415-3875

Organizations & group practices 3

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 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": "1520294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1427550300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9049",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803019049",
            "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": "1645 BROADWAY",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803026218",
            "telephone_number": "303-415-8900",
            "fax_number": "303-443-6476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2575 Spruce St",
            "address_purpose": "LOCATION",
            "city": "Boulder",
            "state": "CO",
            "postal_code": "803023806",
            "country_code": "US",
            "telephone_number": "303-415-3875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLAR",
        "first_name": "KELLY",
        "middle_name": "WOODSIDE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-06",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "PA750",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0005209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.