NPIMap

Individual provider Active NPI

Michael Jay Gottus, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1609987213
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00179400 Issued in NJ
Practice address
1035 Garden of the Gods Rd Ste 120
Colorado Springs, CO 80907-3416
Phone
(719) 365-3200
Fax
(719) 365-7680
NPI assigned
Aug 31, 2006
Last updated
Jan 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2023

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 25MP00179400 NJ Primary

Addresses

Primary practice location

1035 Garden of the Gods Rd Ste 120
Colorado Springs, CO 80907-3416

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (970) 624-2417

Other practice location 1

425 Jack Martin Blvd
Brick, NJ 08724-7732
Phone (732) 840-3380

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
I20201118001662 CO Practitioner - Physician Assistant 3375557150 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
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)

1035 Garden of the Gods Rd
Colorado Springs, CO 80907-9427
Phone (719) 329-1000

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15221CAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince May 30, 2023 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince May 30, 2023 Accepting new patients
Tidal Emergency Physicians LLC Past Accepting new patients
Grapevine Emergency Physicians Medical Group Inc Past Accepting new patients

Locations

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

1035 Garden of the Gods Rd
Ste 120
Colorado Springs, CO 80907
Phone (719) 329-1000

13445 Voyager Pkwy
Colorado Springs, CO 80921
Phone (719) 219-0333

2767 Janitell Rd
Colorado Springs, CO 80906
Phone (719) 365-2888

4323 Integrity Center Pt
Colorado Springs, CO 80917
Phone (719) 591-2558

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

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

11605 Meridian Market Vw
Ste 184
Peyton, CO 80831
Phone (719) 364-9555

Organizations & group practices 4

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673568000000",
    "number": "1609987213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-624-2417",
            "fax_number": "970-652-2927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 GARDEN OF THE GODS RD STE 120",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809073416",
            "telephone_number": "719-365-3200",
            "fax_number": "719-365-7680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 Jack Martin Blvd",
            "address_purpose": "LOCATION",
            "city": "Brick",
            "state": "NJ",
            "postal_code": "087247732",
            "country_code": "US",
            "telephone_number": "732-840-3380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOTTUS",
        "first_name": "MICHAEL",
        "middle_name": "JAY",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00179400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.