Gary Anthony Serravo, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA.0004647 Issued in CO

Practice address

400 W 16TH St
Pueblo, CO 81003-2745

Phone

(719) 584-4306

Fax

(719) 584-4861

NPI assigned

Jun 9, 2016

Last updated

May 18, 2026By 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 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO, NJ, NY, CA, NE5 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 5

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Stationmd Professional CorporationGroup PAC ID 6204184104, 64 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Box Butte General Hospital Hospital, Alliance, NE, CCN 281360
• Mt San Rafael Hospital Hospital, Trinidad, CO, CCN 061321

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.

• Stationmd Professional Corporation

  • Emergency Medicine Physician
  • Maplewood, NJ
  • NPI 1285015347

  CO, NY

  Medicare reassignment Care Compare group
• Box Butte General Hospital

  • Critical Access Hospital
  • Alliance, NE
  • NPI 1811929060
  Medicare reassignment NPD
• Box Butte General Hospital

  dba Greater Nebraska Medical & Surgical Services - Alliance

  • Clinic/Center
  • Alliance, NE
  • NPI 1871652453
  Medicare reassignment NPD
• Stationmd California PC

  • Emergency Medicine Physician
  • Sacramento, CA
  • NPI 1023831922
  Medicare reassignment NPD
• Innova Emergency Medical Associates PC

  • Emergency Medicine Physician
  • Trinidad, CO
  • NPI 1295178978
  Medicare reassignment
• Trinidad Area Health Association

  dba Mt. San Rafael Hospital Clinic

  • Family Medicine Physician
  • Trinidad, CO
  • NPI 1467400309
  Medicare reassignment
• Trinidad Area Health Association

  dba Mt. San Rafael Hospital Specialty Clinics

  • Orthopaedic Surgery Physician
  • Trinidad, CO
  • NPI 1548965999
  NPD
• Box Butte General Hospital

  • Critical Access Hospital Clinic/Center
  • Alliance, NE
  • NPI 1346309929
  NPD
• Box Butte General Hospital

  dba Greater Nebraska Medical & Surgical Services - Hemingford

  • Rural Health Clinic/Center
  • Hemingford, NE
  • NPI 1609944388
  NPD
• Lutheran Hospital Association of the San Luis Valley

  dba San Luis Valley Health Regional Medical Center

  • General Acute Care Hospital
  • Alamosa, CO
  • NPI 1235181744
  NPD (past)

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

• Trinidad Area Health Association

  dba Mt. San Rafael Hospital

  • Critical Access Hospital
  • Trinidad, CO
  • NPI 1184616740
  Care Compare affiliation
• Box Butte General Hospital

  • Critical Access Hospital
  • Alliance, NE
  • NPI 1811929060
  Care Compare affiliation

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

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1679922777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032745",
            "telephone_number": "719-584-4306",
            "fax_number": "719-584-4861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032745",
            "telephone_number": "719-584-4306",
            "fax_number": "719-584-4861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2740 Fulton Ave Ste 220",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958215186",
            "country_code": "US",
            "telephone_number": "877-782-8637",
            "fax_number": "908-934-9564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SERRAVO",
        "first_name": "GARY",
        "middle_name": "ANTHONY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-09",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0004647",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00842600",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "65676",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT STATE CERTIFICATION",
            "identifier": "0004647",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Moira Annette Sergejev, FNP
• Amber Rose Serles, LMT
• Yvonne Serna
• Joel Anthony Serrano-Roman
• Kisha T Serrano, RN, BSN
• Jay Servey
• Hubert T. Servis, MD
• Frank L Settipani, MD
• Kathleen Shafer
• Deborah Ruth Shaffer, CNM

• Medical Physician Assistant in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Medical Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; 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.