Individual provider Active NPI

Peter Jay Ienatsch, PA

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1679608038
Registry record updated Sep 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0004947 Issued in CO
Practice address
2610 Tenderfoot Hill St
Colorado Springs, CO 80906-3981
Phone
(719) 522-1133
Fax
(719) 576-2025
NPI assigned
Feb 23, 2007
Last updated
Sep 24, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0004947 CO Primary

Addresses

Primary practice location

2610 Tenderfoot Hill St
Colorado Springs, CO 80906-3981

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3253

Other practice location 1

559 Vincent St Bldg 959
Peterson AFB, CO 80914-1541
Phone (719) 556-1306

Other identifiers 1

IdentifierTypeStateIssuer
9000168915MedicaidCO

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
I20190910000277 CO Practitioner - Physician Assistant 5395034185 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

Colorado Springs, CO 80903
Phone (719) 538-2900

15909 Jackson Creek Pkwy
Monument, CO 80132-8693
Phone (719) 522-1133

1625 Medical Ctr PT
Suite 290
Colorado Springs, CO 80907-8722
Phone (719) 635-5148

1633 Medical Ctr PT
Colorado Springs, CO 80907-5700
Phone (719) 598-9446

2405 Research Pkwy
Colorado Springs, CO 80920-1044
Phone (719) 268-2800

2610 Tenderfoot Hill St
Colorado Springs, CO 80906-3981
Phone (719) 226-8700

700 W US Hwy 24
Woodland Park, CO 80863-8975
Phone (719) 687-6022

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Optumcare Colorado Medical Group LLC CurrentSince Jun 22, 2019 Accepting new patients
Optumcare Colorado Medical Group LLC CurrentSince Jun 22, 2019 Accepting new patients
Optumcare Colorado Medical Group LLC Past Accepting new patients
Optumcare Colorado Medical Group LLC Past Accepting new patients

Locations

1625 Medical Center Pt
Ste 290
Colorado Springs, CO 80907
Phone (719) 635-5148

2 S Cascade Ave
Ste 140
Colorado Springs, CO 80903
Phone (719) 538-2900

2610 Tenderfoot Hill St
Colorado Springs, CO 80906
Phone (719) 576-3901

2610 Tenderfoot Hill St
Ste 103
Colorado Springs, CO 80906

6025 Delmonico Dr
Colorado Springs, CO 80919
Phone (719) 535-0648

700 W US Highway 24
Woodland Park, CO 80863
Phone (719) 687-6022

Interoperability endpoints

  • Direct secure messaging: pienatsch120999@westdirect.optum.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790208000000",
    "number": "1679608038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 TENDERFOOT HILL ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063981",
            "telephone_number": "719-522-1133",
            "fax_number": "719-576-2025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "559 Vincent St Bldg 959",
            "address_purpose": "LOCATION",
            "city": "Peterson AFB",
            "state": "CO",
            "postal_code": "809141541",
            "country_code": "US",
            "telephone_number": "719-556-1306",
            "fax_number": "719-556-1226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IENATSCH",
        "first_name": "PETER",
        "middle_name": "JAY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2026-09-24",
        "certification_date": "2026-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000168915",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.