Individual provider Active NPI

Robert S Valdez, PA

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1457353260
Registry record updated May 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
704 Issued in CO
Practice address
4110 Briargate Pkwy
Suite 300
Colorado Springs, CO 80920-7835
Phone
(719) 632-7669
Fax
(719) 632-0088
NPI assigned
Aug 11, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2014

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 704 CO Primary

Addresses

Primary practice location

4110 Briargate Pkwy
Suite 300
Colorado Springs, CO 80920-7835

Mailing address

4110 Briargate Pkwy
Suite 300
Colorado Springs, CO 80920-7835
Phone (719) 632-7669

Other identifiers 1

IdentifierTypeStateIssuer
07007040MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050311000368 CO Practitioner - Physician Assistant 7012961030 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Springs Orthopaedic Group CurrentSince Jan 1, 2005 Accepting new patients
Colorado Springs Orthopaedic Group CurrentSince Jan 1, 2005 Accepting new patients

Locations

1259 Lake Plaza Dr
Ste 100
Colorado Springs, CO 80906
Phone (719) 867-7335

4110 Briargate Pkwy
Ste 300
Colorado Springs, CO 80920
Phone (719) 867-7329

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.

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400112000000",
    "number": "1457353260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 BRIARGATE PKWY",
            "address_2": "SUITE 300",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207835",
            "telephone_number": "719-632-7669",
            "fax_number": "719-632-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 BRIARGATE PKWY",
            "address_2": "SUITE 300",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207835",
            "telephone_number": "719-632-7669",
            "fax_number": "719-632-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALDEZ",
        "first_name": "ROBERT",
        "middle_name": "S",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2014-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07007040",
            "state": "CO"
        }
    ],
    "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 May 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.