Individual provider Active NPI

Andres Alejandro Paredes, PA

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1740835602
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
559 Vincent St SPC Base
Colorado Springs, CO 80914-1541
Phone
(719) 524-2273
NPI assigned
Aug 7, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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 Primary

Addresses

Primary practice location

559 Vincent St SPC Base
Colorado Springs, CO 80914-1541

Mailing address

220 Falcon Pkwy
Schriever Afb, CO 80912-5005
Phone (719) 524-2273

Other practice location 1

310 W Losey St
Scott AFB, IL 62225-5250
Phone (618) 256-7192

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20240722000748 IL Practitioner - Physician Assistant 2860938313 Reassigns benefits to 1 organization

National Provider Directory

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

Organizations & group practices 1

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": "1565136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1740835602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 FALCON PKWY",
            "city": "SCHRIEVER AFB",
            "state": "CO",
            "postal_code": "809125005",
            "telephone_number": "719-524-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 VINCENT ST SPC BASE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809141541",
            "telephone_number": "719-524-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 W Losey St",
            "address_purpose": "LOCATION",
            "city": "Scott AFB",
            "state": "IL",
            "postal_code": "622255250",
            "country_code": "US",
            "telephone_number": "618-256-7192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAREDES",
        "first_name": "ANDRES",
        "middle_name": "ALEJANDRO",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-07",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.