NPIMap

Individual provider Active NPI

Elise Van Leuven

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1619612009
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0007973 Issued in CO
Practice address
10807 New Allegiance Dr Ste 160
Colorado Springs, CO 80921-3805
Phone
(719) 249-3547
Fax
(720) 925-5897
NPI assigned
May 1, 2022
Last updated
Mar 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X PA.0007973 CO Primary

Addresses

Primary practice location

10807 New Allegiance Dr Ste 160
Colorado Springs, CO 80921-3805

Mailing address

5445 DTC Pkwy Ste 1130
Greenwood Village, CO 80111-3038
Phone (720) 749-5599

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
I20240410003227 CO Practitioner - Physician Assistant 5496193328 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Colorado School of Medicine, Aurora, 2023
Medicare assignment
May accept Medicare assignment
Group practices
Colorado Dermatology Group PLLCGroup PAC ID 5294022737, 4 clinicians

Practice addresses (Care Compare)

3609 S Timberline Rd
Unit a
Fort Collins, CO 80525-3430
Phone (970) 305-4341

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0007973COMDPhysician Assistant

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1651363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1619612009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5445 DTC PKWY STE 1130",
            "city": "GREENWOOD VILLAGE",
            "state": "CO",
            "postal_code": "801113038",
            "telephone_number": "720-749-5599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10807 NEW ALLEGIANCE DR STE 160",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809213805",
            "telephone_number": "719-249-3547",
            "fax_number": "720-925-5897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN LEUVEN",
        "first_name": "ELISE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-01",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0007973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.