Active NPI
Petra Chladek, PAC
- Physician Assistant
- Steamboat Springs, CO
National Provider Identifier
1619938859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 940 Central Park Dr Ste 210
Steamboat Springs, CO 80487-8853 - Phone
- (970) 871-4811
- NPI assigned
- Mar 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
940 Central Park Dr Ste 210
Steamboat Springs, CO 80487-8853
Mailing address
940 Central Park Dr Ste 210
Steamboat Springs, CO 80487-8853
Phone (970) 871-4811
Other practice location 1
940 Central Park Dr
Ste 100
Steamboat Spgs, CO 80487
Phone (970) 879-3332
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61501743 | Medicaid | CO | |
| 1359 | Other | COLORADO STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051213000730 | CO | Practitioner - Physician Assistant | 7719908110 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- steamboatspringsplasticsurgery.petrachladek@146343.advancedmd-direct.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1619938859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "940 CENTRAL PARK DR STE 210",
"city": "STEAMBOAT SPRINGS",
"state": "CO",
"postal_code": "804878853",
"telephone_number": "970-871-4811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "940 CENTRAL PARK DR STE 210",
"city": "STEAMBOAT SPRINGS",
"state": "CO",
"postal_code": "804878853",
"telephone_number": "970-871-4811"
}
],
"practiceLocations": [
{
"address_1": "940 Central Park Dr",
"address_2": "Ste 100",
"address_purpose": "LOCATION",
"city": "Steamboat Spgs",
"state": "CO",
"postal_code": "80487",
"country_code": "US",
"telephone_number": "970-879-3332",
"fax_number": "970-870-3499",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHLADEK",
"first_name": "PETRA",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-29",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "61501743",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLORADO STATE LICENSE",
"identifier": "1359",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Steamboat Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.