NPIMap

Individual provider Active NPI

Justin L Kidd, PA

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1740279884
Registry record updated Sep 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0003632 Issued in CO
Practice address
1633 Medical Center PT
Colorado Springs, CO 80907-5700
Phone
(719) 473-6155
Fax
(719) 473-3688
NPI assigned
Oct 20, 2005
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.0003632 CO Primary

Addresses

Primary practice location

1633 Medical Center PT
Colorado Springs, CO 80907-5700

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
38527057MedicaidCO

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
I20130916000727 CO Practitioner - Physician Assistant 5092889857 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

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

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
575GAMDPastoral Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Optumcare Colorado Medical Group LLC CurrentSince Nov 1, 2021 Accepting new patients
Optumcare Colorado Medical Group LLC CurrentSince Nov 1, 2021 Accepting new patients
Optumcare Colorado Medical Group LLC Past Accepting new patients

Locations

1615 Medical Center Pt
Colorado Springs, CO 80907
Phone (719) 635-7740

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

1633 Medical Center Pt
Colorado Springs, CO 80907
Phone (719) 636-2999

1633 Medical Center Pt
Fl 2
Colorado Springs, CO 80907

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

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

Hospital & facility affiliations 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790208000000",
    "number": "1740279884",
    "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": "1633 MEDICAL CENTER PT",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809075700",
            "telephone_number": "719-473-6155",
            "fax_number": "719-473-3688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDD",
        "first_name": "JUSTIN",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2026-09-24",
        "certification_date": "2026-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0003632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38527057",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.