K2 Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

K2 DERMATOLOGY, LLC

Practice address

3434 47TH St Ste 200
Boulder, CO 80301-1817

Phone

(303) 444-8100

NPI assigned

Jul 1, 2022

Last updated

Jul 1, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ivy Bradshaw Koger

Title

Practice Manager

Phone

(303) 579-5929

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• William Crane Fix, MD

  • Dermatology Physician
  • Boulder, CO
  • NPI 1063972040
  Medicare reassignment Care Compare group NPD
• Cathy Lynn Koger, D.O.

  • Dermatology Physician
  • Boulder, CO
  • NPI 1902194871
  Medicare reassignment Care Compare group NPD
• Zoe Nikitas

  • Physician Assistant
  • Concord, NH
  • NPI 1932848660

  CO

  Medicare reassignment Care Compare group NPD
• Brenda Winski, NP

  • Nurse Practitioner
  • Michigan City, IN
  • NPI 1174711618

  CO

  Medicare reassignment Care Compare group NPD
• Kirsten Anne Revitte

  • Physician Assistant
  • Boulder, CO
  • NPI 1124636568
  Medicare reassignment Care Compare group
• Shannon Barbara Ross, PA

  • Physician Assistant
  • Boulder, CO
  • NPI 1588621445
  Medicare reassignment Care Compare group
• Samita Shah, PA-C

  • Physician Assistant
  • Brighton, CO
  • NPI 1326436395
  Medicare reassignment
• Brooke Ashley Cerkovnik, PA-C

  • Physician Assistant
  • Cody, WY
  • NPI 1881177079

  CO

  Medicare reassignment

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

{
    "created_epoch": "1656633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656633600000",
    "number": "1558094003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1165 LINDEN CIR",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803040743",
            "telephone_number": "303-579-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 47TH ST STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011817",
            "telephone_number": "303-444-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K2 DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-01",
        "last_updated": "2022-07-01",
        "certification_date": "2022-06-13",
        "status": "A",
        "authorized_official_last_name": "KOGER",
        "authorized_official_first_name": "IVY",
        "authorized_official_middle_name": "BRADSHAW",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "303-579-5929"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linell Juliet, MA
• Anna Jumtina, DDS
• S Suzanne Junered, RD
• Jeanie Jungbauer
• JVDC LLC (Divine Spine Boulder)
• Joanna Mirembe Kabuye
• Elizabeth Ann Kaczmarek, CCC-SLP
• Tessa Kaczor
• Sara Kadlec, PA
• Eve Kagan, LPC

• Dermatology Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.