NPIMap

Individual provider Active NPI

Malena Michelle Nicodemus, PA

  • Physician Assistant
  • Aurora, CO
National Provider Identifier
1720244619
Registry record updated Sep 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2618 Issued in CO
Practice address
2400 S Peoria St
#100
Aurora, CO 80014-5476
Phone
(303) 306-4321
Fax
(303) 306-4347
NPI assigned
Jul 31, 2008
Last updated
Sep 9, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2012

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 2618 CO Primary

Addresses

Primary practice location

2400 S Peoria St
#100
Aurora, CO 80014-5476

Mailing address

2400 S Peoria St
#100
Aurora, CO 80014-5476
Phone (303) 306-4321

Other identifiers 1

IdentifierTypeStateIssuer
91423287MedicaidCO

Other names 1

  • Malena Michelle Doehling Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081009000289 CO Practitioner - Physician Assistant 9234207812 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Colorado School of Medicine, Denver, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wisdom Health PCGroup PAC ID 4284762501, 11 clinicians

Practice addresses (Care Compare)

2919 Valmont Rd
Suite 204
Boulder, CO 80301-1350
Phone 3039381110512

350 Ponca PL
Boulder, CO 80303-3828
Phone (303) 938-1110

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Inpatient Consultants of Colorado PC Physician Assistant CurrentSince Dec 1, 2010 Accepting new patients
Inpatient Consultants of Colorado, PC Physician Assistant Past Accepting new patients
Senior Care of Colorado, PC Geriatric Medicine PastSince Sep 1, 2010 Accepting new patients

Locations

2000 S Colorado Blvd
Ste 420
Denver, CO 80222
Phone (720) 524-1550

Interoperability endpoints

  • Direct secure messaging: malena.nicodemus@96713091579908.direct.elationemr.com

Organizations & group practices 5

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 37

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

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347148800000",
    "number": "1720244619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 S PEORIA ST",
            "address_2": "#100",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800145476",
            "telephone_number": "303-306-4321",
            "fax_number": "303-306-4347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 S PEORIA ST",
            "address_2": "#100",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800145476",
            "telephone_number": "303-306-4321",
            "fax_number": "303-306-4347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICODEMUS",
        "first_name": "MALENA",
        "middle_name": "MICHELLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-31",
        "last_updated": "2012-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "2618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "91423287",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALENA",
            "last_name": "DOEHLING",
            "middle_name": "MICHELLE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.