NPIMap

Individual provider Active NPI

Andrew B. Roberts, M.D.

  • Interventional Pain Medicine Physician
  • Pueblo, CO
National Provider Identifier
1578635371
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
56140 Issued in AZ
Practice address
3530 E Spaulding Ave
Pueblo, CO 81008-2209
Phone
(719) 296-9000
Fax
(719) 296-9001
NPI assigned
Nov 15, 2006
Last updated
Nov 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU
Specialist 174400000X 52254 CO
Interventional Pain Medicine Physician 208VP0014X 62254 CO
Interventional Pain Medicine Physician 208VP0014X 56140 AZ Primary

Addresses

Primary practice location

3530 E Spaulding Ave
Pueblo, CO 81008-2209

Mailing address

3530 E Spaulding Ave
Pueblo, CO 81008-2209
Phone (719) 296-9000

Other identifiers 1

IdentifierTypeStateIssuer
56140OtherAZARIZONA MEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address orthoshana@comcast.net Direct Kenneth D Danylchuk, MD, PC

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
I20190719000047 CO Practitioner - Pain ManagementPractitioner - Anesthesiology 7810986270 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Anesthesiology
Education
JC Edwards School of Medicine, Marshall University, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kenneth D Danylchuk, MD, PCGroup PAC ID 0042204109, 4 clinicians

Practice addresses (Care Compare)

3530 E Spaulding Ave
Pueblo, CO 81008-2209
Phone (719) 296-9000

3530 Spaulding Ave
Peublo, CO 81008-2209

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Laminectomy or laminotomy (partial removal of spine bones)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
52254COMDSpecialist
62254COMDInterventional Pain Medicine Physician
22909SCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kenneth D Danylchuk, MD, PC Specialist CurrentSince Apr 1, 2020 Accepting new patients

Locations

3530 E Spaulding Ave
Pueblo, CO 81008
Phone (719) 296-0077

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

Hospital & facility affiliations 10

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": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1578635371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3530 E SPAULDING AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082209",
            "telephone_number": "719-296-9000",
            "fax_number": "719-296-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3530 E SPAULDING AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082209",
            "telephone_number": "719-296-9000",
            "fax_number": "719-296-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "ANDREW",
        "middle_name": "B.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2023-11-27",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CO",
            "license": "52254",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CO",
            "license": "62254",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "AZ",
            "license": "56140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA MEDICAL LICENSE",
            "identifier": "56140",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "orthoshana@comcast.net",
            "affiliation": "Y",
            "affiliationName": "Kenneth D Danylchuk, MD, PC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3530 E Spaulding Ave",
            "city": "Pueblo",
            "state": "CO",
            "country_code": "US",
            "postal_code": "810082209",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.