NPIMap

Individual provider Active NPI

Luis Santiago, PA-C

  • Physician Assistant
  • Ft. Carson, CO
National Provider Identifier
1770526303
Registry record updated Jul 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0002445 Issued in CO
Practice address
3Acr BLDG 1650, Barkley Ave
Ft. Carson, CO 80913
Phone
(719) 526-6699
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X PA.0002445 CO Primary

Addresses

Primary practice location

3Acr BLDG 1650, Barkley Ave
Ft. Carson, CO 80913

Mailing address

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538-9071
Phone (970) 624-4036

Other identifiers 1

IdentifierTypeStateIssuer
03025551MedicaidCO

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
I20150622001007 CO Practitioner - Physician Assistant 7810208543 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1035 Garden of the Gods Rd
Colorado Springs, CO 80907-9427
Phone (719) 329-1000

4323 Integrity Ctr PT
Colorado Springs, CO 80917-1683
Phone (719) 591-2558

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

State licenses

LicenseStateTypeSpecialty
2445COMDOptometrist
PA.0002445COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Aug 9, 2016 Accepting new patients
Integrity Urgent Care, P.C. Past Accepting new patients

Locations

4404 Barranca Ln
Ste 101
Castle Rock, CO 80104
Phone (720) 733-5260

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

13445 Voyager Pkwy
Colorado Springs, CO 80921
Phone (719) 219-0333

1035 Garden of the Gods Rd
Ste 120
Colorado Springs, CO 80907
Phone (719) 329-1000

4323 Integrity Center Pt
Colorado Springs, CO 80917
Phone (719) 591-2558

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

11605 Meridian Market Vw
Ste 184
Peyton, CO 80831
Phone (719) 364-9555

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.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469577600000",
    "number": "1770526303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE",
            "address_2": "STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-624-4036",
            "fax_number": "970-490-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3ACR BLDG 1650, BARKLEY AVE",
            "city": "FT. CARSON",
            "state": "CO",
            "postal_code": "80913",
            "telephone_number": "719-526-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTIAGO",
        "first_name": "LUIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2016-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0002445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03025551",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft. Carson, CO

Sources for this page

Verify at the official NPI Registry.