Individual provider Active NPI

Grace Smith, P.A.-C

  • Medical Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1578253357
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
8948 Issued in CO
Practice address
5715 Kittery Dr
Colorado Springs, CO 80911-3551
Phone
(719) 392-3883
Fax
(719) 390-6338
NPI assigned
May 15, 2023
Last updated
Feb 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 8948 CO Primary

Addresses

Primary practice location

5715 Kittery Dr
Colorado Springs, CO 80911-3551

Mailing address

5715 Kittery Dr
Colorado Springs, CO 80911-3551
Phone (719) 392-3883

Other identifiers 1

IdentifierTypeStateIssuer
8948OtherCOCOLORADO LICENSE

Other names 1

  • Grace Williams Former name

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
I20260407001824 CO Practitioner - Physician Assistant 2668994088 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Rocky Vista University College of Osteopathic Med, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Housecalls LLCGroup PAC ID 0840212809, 124 clinicians

Practice addresses (Care Compare)

12600 W Colfax Ave
Suite B200
Lakewood, CO 80215-3736
Phone (720) 923-1250

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8948COMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Dynamic Family Medicine PLLC CurrentSince Feb 23, 2025 Accepting new patients

Locations

5715 Kittery Dr
Colorado Springs, CO 80911
Phone (719) 390-6338

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1578253357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5715 KITTERY DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809113551",
            "telephone_number": "719-392-3883",
            "fax_number": "719-390-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5715 KITTERY DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809113551",
            "telephone_number": "719-392-3883",
            "fax_number": "719-390-6338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GRACE",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-15",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "8948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO LICENSE",
            "identifier": "8948",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "WILLIAMS",
            "credential": "P.A.-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.