Individual provider Active NPI

Rudolph Bonham Maxey Moravek, P.A.

  • Medical Physician Assistant
  • Aurora, CO
National Provider Identifier
1700215993
Registry record updated Oct 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.0004210 Issued in CO
Practice address
12605 E 16TH Ave
Aurora, CO 80045-2545
Phone
(720) 848-0000
NPI assigned
Nov 7, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0004210 CO
Physician Assistant 363A00000X 2945 CT
Medical Physician Assistant 363AM0700X 017155-1 NY
Medical Physician Assistant 363AM0700X PA.0004210 CO Primary

Addresses

Primary practice location

12605 E 16TH Ave
Aurora, CO 80045-2545

Mailing address

PO Box 110429
Aurora, CO 80042-0429
Phone (303) 493-7000

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
I20150323000792 CO Practitioner - Physician Assistant 3072735422 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0004210COMDPhysician Assistant
2945CTMDPhysician Assistant
017155-1NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians, Incorporated CurrentSince May 1, 2016 Accepting new patients
University Physicians Incorporated CurrentSince May 1, 2016 Accepting new patients
University Physicians Incorporated Physician Assistant Past Accepting new patients

Locations

12605 E 16th Ave
Aurora, CO 80045
Phone (720) 848-0006

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

Organizations & group practices 3

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": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539820800000",
    "number": "1700215993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110429",
            "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": "12605 E 16TH AVE",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800452545",
            "telephone_number": "720-848-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORAVEK",
        "first_name": "RUDOLPH",
        "middle_name": "BONHAM MAXEY",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-07",
        "last_updated": "2018-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004210",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "2945",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "017155-1",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0004210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.