NPIMap

Individual provider Active NPI

Annika Svea Kostrubala, PA

  • Physician Assistant
  • Fort Collins, CO
National Provider Identifier
1750647244
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0004033 Issued in CO
Practice address
2121 E Harmony Rd Unit 300
Fort Collins, CO 80528
Phone
(970) 224-9102
Fax
(970) 224-9112
NPI assigned
Apr 9, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2701 SC
Physician Assistant 363A00000X PA.0004033 CO Primary

Addresses

Primary practice location

2121 E Harmony Rd Unit 300
Fort Collins, CO 80528

Mailing address

2121 E Harmony Rd Unit 300
Fort Collins, CO 80528-3403
Phone (970) 224-9102

Other identifiers 3

IdentifierTypeStateIssuer
1750647244MedicaidNC
66758076MedicaidCO
1433PAMedicaidSC

Other names 1

  • Annika Kamberelis Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140828001295 CO Practitioner - Physician Assistant 2860656006 Reassigns benefits to 2 organizations
I20180319002580 SC Practitioner - Physician Assistant 2860656006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wayne State University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

2121 E Harmony Rd
Fort Collins, CO 80528-3403

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Sep 29, 2014 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Sep 29, 2014 Accepting new patients
Prisma Health University Medical Group CurrentSince Feb 12, 2018 Accepting new patients
Henderson County Hospital Corporation CurrentSince Mar 1, 2017 Accepting new patients
Henderson County Hospital Corp CurrentSince Mar 1, 2017 Accepting new patients
Carolina Mountain Emergency Medicine PA Past Accepting new patients
Origin Healthcare, LLC Past Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

2121 E Harmony Rd
Unit 300
Fort Collins, CO 80528
Phone (970) 224-0429

1024 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 495-7000

6767 29th St
Greeley, CO 80634
Phone (970) 652-2000

6767 29th St
Fl 2
Greeley, CO 80634
Phone (970) 652-2433

2500 Rocky Mountain Ave
Ste 300
Loveland, CO 80538
Phone (970) 619-6100

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

21 Turtle Creek Dr
Ste 100
Asheville, NC 28803
Phone (828) 435-8394

800 N Justice St
Hendersonvlle, NC 28791
Phone (828) 696-1000

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

Organizations & group practices 9

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.

Hospital & facility affiliations 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1333929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1750647244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD UNIT 300",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283403",
            "telephone_number": "970-224-9102",
            "fax_number": "970-224-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD UNIT 300",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80528",
            "telephone_number": "970-224-9102",
            "fax_number": "970-224-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTRUBALA",
        "first_name": "ANNIKA",
        "middle_name": "SVEA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-09",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2701",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750647244",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "66758076",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1433PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNIKA",
            "last_name": "KAMBERELIS",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.