Zachary Wajvoda, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

54127 Issued in CA

Practice address

15301 Warren Shingle Rd
Beale AFB, CA 95903-1905

Phone

(219) 798-0474

NPI assigned

Feb 25, 2014

Last updated

Jan 3, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, CO2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner Health Physicians Colorado LLCGroup PAC ID 8921273038, 278 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner North Colorado Medical Center Hospital, Greeley, CO, CCN 060001
• East Morgan County Hospital Hospital, Brush, CO, CCN 061303
• Sterling Regional Medcenter Hospital, Sterling, CO, CCN 060076

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Banner Health Physicians Colorado LLC

  • Multi-Specialty Clinic/Center
  • Greeley, CO
  • NPI 1073899134
  Medicare reassignment Care Compare group NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Banner Health Physicians Colorado LLC

  • Multi-Specialty Clinic/Center
  • Torrington, WY
  • NPI 1215375688
  NPD
• Banner Health Physicians Colorado LLC

  • Multi-Specialty Clinic/Center
  • Windsor, CO
  • NPI 1831476381
  NPD (past)

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

• East Morgan County Hospital

  • Critical Access Hospital
  • Brush, CO
  • NPI 1699708743
  Care Compare affiliation
• North Colorado Medical Center

  • General Acute Care Hospital
  • Loveland, CO
  • NPI 1174231682
  Care Compare affiliation
• North Colorado Medical Center

  • Critical Access Hospital
  • Greeley, CO
  • NPI 1255971404
  Care Compare affiliation
• North Colorado Medical Center

  • Ambulance
  • Greeley, CO
  • NPI 1457850430

  Hospital

  Care Compare affiliation
• North Colorado Medical Center

  • General Acute Care Hospital
  • Greeley, CO
  • NPI 1477376986
  Care Compare affiliation
• North Colorado Medical Center

  • Special Hospital
  • Loveland, CO
  • NPI 1487535431
  Care Compare affiliation
• North Colorado Medical Center

  • Critical Access Hospital
  • Greeley, CO
  • NPI 1578103750
  Care Compare affiliation
• North Colorado Medical Center

  • Emergency Care Clinic/Center
  • Greeley, CO
  • NPI 1588928519

  Hospital

  Care Compare affiliation
• North Colorado Medical Center

  • Infusion Therapy Clinic/Center
  • Loveland, CO
  • NPI 1700668183

  Hospital

  Care Compare affiliation
• North Colorado Medical Center

  • General Acute Care Hospital
  • Greeley, CO
  • NPI 1720004450
  Care Compare affiliation
• North Colorado Medical Center

  • Critical Access Hospital
  • Greeley, CO
  • NPI 1831739267
  Care Compare affiliation
• North Colorado Medical Center

  • Ambulance
  • Greeley, CO
  • NPI 1861989212

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1393286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1669897849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15301 WARREN SHINGLE RD",
            "city": "BEALE AFB",
            "state": "CA",
            "postal_code": "959031905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15301 WARREN SHINGLE RD",
            "city": "BEALE AFB",
            "state": "CA",
            "postal_code": "959031905",
            "telephone_number": "219-798-0474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAJVODA",
        "first_name": "ZACHARY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-25",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2025 Morse Ave",
            "city": "Sacramento",
            "state": "CA",
            "country_code": "US",
            "postal_code": "958252115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vladimir Vader, DMD
• Jeffrey M Van Ness, DMD
• Richelle L Vanburen-Walls, LSW
• Lijah Vann Gardner, DO
• Paul D Vu, M.D.
• Wesley Wander, D.O.
• Kelly Neil West, M.D.
• Eric J. Westergard, DDS
• Stephen Michael Wheeler, IDMT
• David Whitehorn

• Physician Assistant in Beale AFB, CA
• Providers in Beale AFB, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.