NPIMap

Individual provider Active NPI

Andrea J Nettles, PA

  • Medical Physician Assistant
  • Greeley, CO
National Provider Identifier
1568544906
Registry record updated May 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2005029532 Issued in MO
Practice address
2001 70TH Ave Ste 110
Greeley, CO 80634-4628
Phone
(970) 378-4155
NPI assigned
Oct 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2005029532 MO Primary
Medical Physician Assistant 363AM0700X 1501043 KS

Addresses

Primary practice location

2001 70TH Ave Ste 110
Greeley, CO 80634-4628

Mailing address

2001 70TH Ave Ste 110
Greeley, CO 80634-4628
Phone (970) 378-4155

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
I20090925000120 CO Practitioner - Physician Assistant 5799706438 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Current Care PAGroup PAC ID 9739260019, 545 clinicians
Banner Health Physicians Colorado LLCGroup PAC ID 8921273038, 278 clinicians

Practice addresses (Care Compare)

1730 Blake St
Suite 100
Denver, CO 80202-1274
Phone (303) 296-2273

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4121

2555 E 13TH St
Suite 105
Loveland, CO 80537-5134
Phone (970) 820-6300

5890 W 13TH St
Greeley, CO 80634-4821

620 S Lemay Ave
Fort Collins, CO 80524-3543
Phone (970) 482-6620

Hospital & facility affiliations

  • Banner North Colorado Medical Center Hospital, Greeley, CO, CCN 060001

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1501043KSMDMedical Physician Assistant
2005029532MOMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince Jan 1, 2012 Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Apr 13, 2020 Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Apr 13, 2020 Accepting new patients
American Current Care PA CurrentSince Aug 8, 2022 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Jan 1, 2012 Accepting new patients
Big Thompson Emergency Physicians, PC CurrentSince May 3, 2013 Accepting new patients
American Current Care P.a. CurrentSince Aug 8, 2022 Accepting new patients
Banner Medical Group Greeley LLC Past Accepting new patients
Big Thompson Medical Group Inc Past Accepting new patients
Banner Health Physicians Colorado LLC Past Accepting new patients
North Colorado Emergency Physicians, PC Past Accepting new patients

Locations

1730 Blake St
Ste 100
Denver, CO 80202
Phone (303) 296-2273

2001 70th Ave
Ste 110
Greeley, CO 80634
Phone (970) 378-4155

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

5890 W 13th St
Ste 101
Greeley, CO 80634
Phone (970) 348-0020

2000 Boise Ave
Loveland, CO 80538
Phone (970) 635-4071

Organizations & group practices 12

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369872000000",
    "number": "1568544906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 70TH AVE STE 110",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806344628",
            "telephone_number": "970-378-4155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 70TH AVE STE 110",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806344628",
            "telephone_number": "970-378-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLES",
        "first_name": "ANDREA",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2013-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": "2005029532",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KS",
            "license": "1501043",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

Verify at the official NPI Registry.