Individual provider Active NPI

Kevin H Christopherson, PA-C

  • Medical Physician Assistant
  • Denver, CO
National Provider Identifier
1538738232
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA0007945 Issued in CO
Practice address
777 Bannock St # Mc3240
Denver, CO 80204-4597
Phone
(303) 436-6000
NPI assigned
Jun 18, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MA062573 PA
Family Medicine Physician 207Q00000X PA0007945 CO
Medical Physician Assistant 363AM0700X MA062573 PA
Medical Physician Assistant 363AM0700X PA0007945 CO Primary

Addresses

Primary practice location

777 Bannock St # Mc3240
Denver, CO 80204-4597

Mailing address

1023 Poplar St
Lebanon, PA 17042-6636
Phone (717) 270-9446

Other practice location 1

1023 Poplar St
Lebanon, PA 17042-6636
Phone (717) 270-9446

Other identifiers 1

IdentifierTypeStateIssuer
1039356650001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, CO2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210629001137 PA Practitioner - Physician Assistant 3173924198
I20231229001886 CO Practitioner - Physician Assistant 3173924198 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA0007945COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Denver Health and Hospital Authority CurrentSince Nov 15, 2023 Accepting new patients
Denver Health and Hospital Authority CurrentSince Nov 15, 2023 Accepting new patients
Denver Health and Hospital Authority Past Accepting new patients

Locations

4545 Navajo St
Denver, CO 80211
Phone (303) 436-8700

777 Bannock St
#3240
Denver, CO 80204
Phone (303) 602-2714

777 Bannock St
Denver, CO 80204

Interoperability endpoints

  • Direct secure messaging: kchristopherson292966@direct.dhha.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1538738232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 POPLAR ST",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170426636",
            "telephone_number": "717-270-9446",
            "fax_number": "717-270-5669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 BANNOCK ST # MC3240",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802044597",
            "telephone_number": "303-436-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1023 Poplar St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170426636",
            "country_code": "US",
            "telephone_number": "717-270-9446",
            "fax_number": "717-270-5669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHRISTOPHERSON",
        "first_name": "KEVIN",
        "middle_name": "H",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-18",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MA062573",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "PA0007945",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA062573",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA0007945",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1039356650001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.