Individual provider Active NPI

Anna L Bruckner, MD

  • Pediatric Dermatology Physician
  • Aurora, CO
National Provider Identifier
1649354150
Registry record updated Oct 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Dermatology PhysicianTaxonomy code 207NP0225X
License
37780 Issued in CO
Practice address
13123 E 16TH Ave
Children'S Hospital Colorado
Aurora, CO 80045-7106
Phone
(720) 777-1234
NPI assigned
Oct 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 37780 CO
Pediatric Dermatology Physician 207NP0225X 37780 CO Primary

Addresses

Primary practice location

13123 E 16TH Ave
Children'S Hospital Colorado
Aurora, CO 80045-7106

Mailing address

PO Box 110429
University Physicians, Inc.
Aurora, CO 80042-0429
Phone (303) 493-7000

Other identifiers 1

IdentifierTypeStateIssuer
14651084MedicaidCO

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110921000708 CO Practitioner - DermatologyPractitioner - Pediatric Medicine 1355315235 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
DermatologyAlso: Pediatric Medicine
Education
Northwestern University Feinberg Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physicians IncorporatedGroup PAC ID 3476465667, 3,189 clinicians

Practice addresses (Care Compare)

13123 E 16TH Ave
Aurora, CO 80045-7106
Phone (720) 777-1234

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37780COMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Denver Health and Hospital Authority CurrentSince Mar 1, 2015 Accepting new patients
Denver Health and Hospital Authority CurrentSince Mar 1, 2015 Accepting new patients
Children'S Hospital Colorado Current Accepting new patients
University Physicians, Incorporated CurrentSince Jul 14, 2011 Accepting new patients
University Physicians Incorporated Dermatology CurrentSince Jul 14, 2011 Accepting new patients

Locations

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

13123 E 16th Ave
Ste B130
Aurora, CO 80045

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

4090 Briargate Pkwy
Colorado Springs, CO 80920
Phone (719) 305-1234

777 Bannock St
Denver, CO 80204

Dept 1061
Denver, CO 80256

Interoperability endpoints

  • Direct secure messaging: abruckner14046@direct.childrenscolorado.org

Organizations & group practices 5

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": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349308800000",
    "number": "1649354150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110429",
            "address_2": "UNIVERSITY PHYSICIANS, INC.",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800420429",
            "telephone_number": "303-493-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13123 E 16TH AVE",
            "address_2": "CHILDREN'S HOSPITAL COLORADO",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800457106",
            "telephone_number": "720-777-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKNER",
        "first_name": "ANNA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2012-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": "37780",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "CO",
            "license": "37780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14651084",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.