NPIMap

Individual provider Active NPI

Katherine Kowalk, PA-C

  • Physician Assistant
  • Fort Collins, CO
National Provider Identifier
1790382240
Registry record updated Oct 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0006186 Issued in CO
Practice address
3108 Bryce Dr
Fort Collins, CO 80525-3119
Phone
(630) 525-1631
NPI assigned
Oct 7, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2020

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 0006186 CO Primary

Addresses

Primary practice location

3108 Bryce Dr
Fort Collins, CO 80525-3119

Mailing address

3108 Bryce Dr
Fort Collins, CO 80525-3119
Phone (630) 525-1631

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
I20210120002112 CO Practitioner - Physician Assistant 0244644953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advanced Urology PLLCGroup PAC ID 2365346558, 58 clinicians

Practice addresses (Care Compare)

10535 Park Meadows Blvd
Suite 102
Lone Tree, CO 80124-8455
Phone (303) 695-6106

32135 Castle CT
Suite 101
Evergreen, CO 80439-8006
Phone (303) 985-2550

4500 E 9TH Ave
Suite 470
Denver, CO 80220-3923
Phone (303) 532-8007

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0006186COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Urology, PLLC Current Accepting new patients
Foothills Urology, PC Current Accepting new patients
Advanced Urology, PLLC CurrentSince Jan 1, 2021 Accepting new patients

Locations

4350 Limelight Ave
Unit 250
Castle Rock, CO 80109
Phone (303) 697-1636

4500 E 9th Ave
Ste 470
Denver, CO 80220
Phone (303) 320-8499

1411 S Potomac St
Ste 210
Denver, CO 80012
Phone (303) 750-0883

4700 Hale Pkwy
Denver, CO 80220
Phone (303) 321-0302

32135 Castle Ct
Ste 101
Evergreen, CO 80439
Phone (303) 679-8500

10535 Park Meadows Blvd
Ste 102
Lone Tree, CO 80124
Phone (303) 695-1211

25 Crossroads Dr
Ste 306
Owings Mills, MD 21117
Phone (443) 231-1681

Interoperability endpoints

  • Direct secure messaging: katherinekowalk@fu.allscriptsdirect.net

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1602028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1790382240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3108 BRYCE DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253119",
            "telephone_number": "630-525-1631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3108 BRYCE DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253119",
            "telephone_number": "630-525-1631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALK",
        "first_name": "KATHERINE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-07",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "0006186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.