Individual provider Active NPI

Moriah Mackenzie Schaller, PA-C

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1578174934
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0006443 Issued in CO
Practice address
3920 N Union Blvd
Colorado Springs, CO 80907-4900
Phone
(303) 338-4545
NPI assigned
Aug 11, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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 PA.0006443 CO Primary

Addresses

Primary practice location

3920 N Union Blvd
Colorado Springs, CO 80907-4900

Mailing address

10350 E Dakota Ave
Denver, CO 80247-1314

Other identifiers 1

IdentifierTypeStateIssuer
9000191209MedicaidCO

Other names 1

  • Moriah Mackenzie Kunau Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20210322002758 CO Practitioner - Physician Assistant 5698182467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Colorado Permanente Medical Group PCGroup PAC ID 1254238454, 1,325 clinicians

Practice addresses (Care Compare)

10240 Park Meadows Dr
Lone Tree, CO 80124-5425
Phone (303) 338-4545

10350 E Dakota Ave
Denver, CO 80247-1314

10350 E Dakota Avenue B
Kaiser Permanente High
Denver, CO 80247-1314
Phone (303) 338-4545

10350 E Dakota Avenue C
Kaiser Permanente Highline Chemical
Denver, CO 80247-1314
Phone (303) 338-4545

1375 E 20TH Ave
Kaiser Permanente Skyline Medical Offices
Denver, CO 80205-5422
Phone (303) 338-4545

3920 N Union Boulevard
Kaiser Permanente Premier Medical Offices
Colorado Springs, CO 80907-4900
Phone (303) 338-4545

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0006443COMDPhysician Assistant

Organizations & group practices 1

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": "1597104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1578174934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10350 E DAKOTA AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802471314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3920 N UNION BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809074900",
            "telephone_number": "303-338-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHALLER",
        "first_name": "MORIAH",
        "middle_name": "MACKENZIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-11",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0006443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000191209",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3920 N Union Blvd",
            "city": "Colorado Springs",
            "state": "CO",
            "country_code": "US",
            "postal_code": "809074900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MORIAH",
            "last_name": "KUNAU",
            "middle_name": "MACKENZIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.