NPIMap

Individual provider Active NPI

Gregory J Haubrich, PAC

  • Physician Assistant
  • Pueblo, CO
National Provider Identifier
1588816722
Registry record updated May 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0003032 Issued in CO
Practice address
400 W 16TH St
Pueblo, CO 81003-2745
Phone
(719) 584-4306
Fax
(719) 595-7886
NPI assigned
Oct 21, 2008
Last updated
May 6, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9104817 FL
Physician Assistant 363A00000X PA.0003032 CO Primary

Addresses

Primary practice location

400 W 16TH St
Pueblo, CO 81003-2745

Mailing address

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4306

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
I20100826001049 CO Practitioner - Physician Assistant 0840359303 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11600 W 2ND PL
Lakewood, CO 80228-1527
Phone (720) 321-4161

2222 N Nevada Ave
Colorado Springs, CO 80907-6794
Phone (719) 776-5333

6001 E Woodman Rd
Colorado Springs, CO 80923-2601
Phone (719) 571-1476

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.85 of 100Reported as group
Quality
91.15
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Usacs Observation Medicine Services of Colorado Inc. CurrentSince Jun 5, 2018 Accepting new patients
Usacs Observation Medicine Services of Colorado Inc. CurrentSince Jun 5, 2018 Accepting new patients
Usacs of Colorado Inc CurrentSince Jun 5, 2018 Accepting new patients
Usacs of Colorado Inc CurrentSince Jun 5, 2018 Accepting new patients
Epn Family Care LLC Family Medicine Past Accepting new patients
Epn Urgent Care LLC Past Accepting new patients
Front Range Emergency Specialists, PC Past Accepting new patients
Emergency Physicians of Naples PLLC Past Accepting new patients

Locations

10860 New Allegiance Dr
Colorado Springs, CO 80921
Phone (719) 757-7000

2222 N Nevada Ave
Colorado Springs, CO 80907
Phone (719) 776-5333

6001 E Woodmen Rd
Colorado Springs, CO 80923
Phone (719) 571-1000

11600 W 2nd Pl
Lakewood, CO 80228
Phone (720) 321-1010

7700 S Broadway
Littleton, CO 80122
Phone (303) 269-4786

Organizations & group practices 11

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 2

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": "1224547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399334400000",
    "number": "1588816722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032745",
            "telephone_number": "719-584-4306",
            "fax_number": "719-595-7886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032745",
            "telephone_number": "719-584-4306",
            "fax_number": "719-595-7886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUBRICH",
        "first_name": "GREGORY",
        "middle_name": "J",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-21",
        "last_updated": "2014-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104817",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0003032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.