NPIMap

Individual provider Active NPI

Kimberly Racine, PA-C

  • Physician Assistant
  • Loveland, CO
National Provider Identifier
1598737975
Registry record updated Oct 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1481 Issued in CO
Practice address
3850 N Grant Ave Ste 200
Loveland, CO 80538-8431
Phone
(970) 624-5170
Fax
(970) 669-7521
NPI assigned
Feb 1, 2006
Last updated
Oct 8, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2021

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 1481 CO Primary

Addresses

Primary practice location

3850 N Grant Ave Ste 200
Loveland, CO 80538-8431

Mailing address

3850 N Grant Ave Ste 200
Loveland, CO 80538
Phone (970) 624-5170

Other identifiers 2

IdentifierTypeStateIssuer
P00944762OtherCOMEDICARE RAILROAD CARRIER PTAN
61624349MedicaidCO

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
I20100126000661 CO Practitioner - Physician Assistant 9638211899 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

6767 29TH St
Greeley, CO 80634-5474
Phone (970) 224-3636

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1481COMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Oct 3, 2010 Accepting new patients
Poudre Valley Medical Group, LLC Past Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

5965 Firestone Blvd
Firestone, CO 80504
Phone (720) 652-7055

2127 E Harmony Rd
Ste 140
Fort Collins, CO 80528
Phone (970) 207-4800

3519 Richmond Dr
Fort Collins, CO 80526
Phone (970) 204-0300

1900 16th St
Greeley, CO 80631
Phone (970) 350-2438

5881 W 16th St
Ste A
Greeley, CO 80634
Phone (970) 652-2447

6767 29th St
Greeley, CO 80634
Phone (970) 652-2000

6767 29th St
Fl 2
Greeley, CO 80634
Phone (970) 652-2433

4846 Larimer Pkwy
Bldg 1
Johnstown, CO 80534
Phone (970) 624-2830

2101 Main St
Longmont, CO 80501
Phone (720) 745-8030

221 E 29th St
Ste 102
Loveland, CO 80538
Phone (970) 224-3636

2500 Rocky Mountain Ave
Ofc
Loveland, CO 80538
Phone (970) 203-7050

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

3850 Grant Ave
Ste 200
Loveland, CO 80538
Phone (970) 624-5170

Organizations & group practices 3

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633651200000",
    "number": "1598737975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 N GRANT AVE STE 200",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "80538",
            "telephone_number": "970-624-5170",
            "fax_number": "970-669-7521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 N GRANT AVE STE 200",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805388431",
            "telephone_number": "970-624-5170",
            "fax_number": "970-669-7521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACINE",
        "first_name": "KIMBERLY",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-01",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "1481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD CARRIER PTAN",
            "identifier": "P00944762",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61624349",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.