Individual provider Active NPI

Brandon Gregory Smith, PA-C

  • Medical Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1649479031
Registry record updated Sep 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-2496 Issued in CO
Practice address
1400 E Boulder St
Suite 700
Colorado Springs, CO 80909-5533
Phone
(719) 635-7172
Fax
(719) 444-3771
NPI assigned
Jul 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA-2496 CO Primary

Addresses

Primary practice location

1400 E Boulder St
Suite 700
Colorado Springs, CO 80909-5533

Mailing address

2222N Nevada Ave 4007
Colorado Springs, CO 80907-6863
Phone (719) 776-8500

Other identifiers 1

IdentifierTypeStateIssuer
96130857MedicaidCO

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
I20071017000372 CO Practitioner - Physician Assistant 8729174149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CS Cardiology Newco LLCGroup PAC ID 2365805736, 46 clinicians

Practice addresses (Care Compare)

2222 N Nevada Ave
Suite 4007
Colorado Springs, CO 80907-6819

Hospital & facility affiliations

  • Centura Health-Penrose St Francis Health Services Hospital, Colorado Springs, CO, CCN 060031

Merit-based Incentive Payment System (MIPS)

Final score
89.06 of 100Reported as group
Quality
89.53
Promoting interoperability
100
Improvement activities
40
Cost
74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA-2496COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
CS Cardiology Newco LLC CurrentSince Sep 1, 2023 Accepting new patients
Pikes Peak Cardiology a Professional LLP Past Accepting new patients
CS Cardiology Newco LLC Past Accepting new patients

Locations

2222 N Nevada Ave
Ste 4007
Colorado Springs, CO 80907
Phone (719) 634-6671

904 E Hailey Ln
Ste C
Pueblo West, CO 81007

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442188800000",
    "number": "1649479031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222N NEVADA AVE 4007",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076863",
            "telephone_number": "719-776-8500",
            "fax_number": "719-634-1448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E BOULDER ST",
            "address_2": "SUITE 700",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095533",
            "telephone_number": "719-635-7172",
            "fax_number": "719-444-3771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BRANDON",
        "middle_name": "GREGORY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-16",
        "last_updated": "2015-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA-2496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "96130857",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.