Individual provider Active NPI

Laura Zoe Entin Smith, PA-C

  • Physician Assistant
  • Boulder, CO
National Provider Identifier
1629329487
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3490 Issued in CO
Practice address
4740 Pearl Pkwy Ste 200
Boulder, CO 80301-3080
Phone
(215) 829-2010
NPI assigned
Sep 19, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

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 MA057514 PA
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 3490 CO Primary

Addresses

Primary practice location

4740 Pearl Pkwy Ste 200
Boulder, CO 80301-3080

Mailing address

4740 Pearl Pkwy Ste 200
Boulder, CO 80301-3080
Phone (303) 449-2730

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190510000103 CO Practitioner - Physician Assistant 5193034734 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bouldercentre for Orthopedics PCGroup PAC ID 3971409020, 56 clinicians

Practice addresses (Care Compare)

4740 Pearl Pkwy
Suite 200
Boulder, CO 80301-3080
Phone (303) 449-2730

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3490COMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Bouldercentre for Orthopedics Multi-Specialty PastSince Feb 11, 2024 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: laura.zoe.entin.smith.1@3497.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/3497/brand/1/csg/21/fhir/r4

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741305600000",
    "number": "1629329487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 PEARL PKWY STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803013080",
            "telephone_number": "303-449-2730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 PEARL PKWY STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803013080",
            "telephone_number": "215-829-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LAURA",
        "middle_name": "ZOE ENTIN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-19",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA057514",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "3490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.