NPIMap

Individual provider Active NPI

Izaak D Fitzgerald, PA

  • Surgical Physician Assistant
  • Glenwood Springs, CO
National Provider Identifier
1811095219
Registry record updated Jun 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA-2255 Issued in CO
Practice address
1830 Blake Ave
Ste 206
Glenwood Springs, CO 81601-4227
Phone
(970) 384-7140
NPI assigned
Sep 20, 2006
Last updated
Jun 23, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA-2255 CO Primary

Addresses

Primary practice location

1830 Blake Ave
Ste 206
Glenwood Springs, CO 81601-4227

Mailing address

1830 Blake Ave
Ste 206
Glenwood Springs, CO 81601-4227
Phone (970) 384-7140

Other identifiers 1

IdentifierTypeStateIssuer
36780758MedicaidCO

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
I20061114000614 CO Practitioner - Physician Assistant 8527066125 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Valley View Hospital AssociationGroup PAC ID 1850294778, shared by 23 NPIs, 205 clinicians

Practice addresses (Care Compare)

1906 Blake Ave
Glenwood SPGS, CO 81601-4227

1906 Blake Ave
Glenwood SPGS, CO 81601-4259

2001 N Horseshoe TRL
Silt, CO 81652-9832
Phone (970) 945-6533

350 Market St
Basalt, CO 81621-7403

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA-2255COMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Valley View Hospital Association CurrentSince Jul 1, 2014 Accepting new patients
Valley View Hospital Association Surgical CurrentSince Jul 1, 2014 Accepting new patients
Pathology Assoc of the Roaring Fork Current Accepting new patients
Valley View Hospital Association CurrentSince Mar 1, 2024 Accepting new patients
Valley View Hospital Association CurrentSince Jul 1, 2014 Accepting new patients
Valley View Hospital Association Current Accepting new patients
Valley View Hospital Association Current Accepting new patients
Valley View Hospital Association Past Accepting new patients
Orthopaedic Associates of Aspen and Glenwood Past Accepting new patients

Locations

1450 E Valley Rd
Unit 201
Basalt, CO 81621
Phone (970) 927-1757

1906 Blake Ave
Glenwood Springs, CO 81601
Phone (970) 384-7033

1830 Blake Ave
Ste 206
Glenwood Springs, CO 81601
Phone (970) 928-0808

Interoperability endpoints

  • Direct secure messaging: izaak.fitzgerald.4@9028.direct.athenahealth.com

Organizations & group practices 12

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435017600000",
    "number": "1811095219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 BLAKE AVE",
            "address_2": "STE 206",
            "city": "GLENWOOD SPRINGS",
            "state": "CO",
            "postal_code": "816014227",
            "telephone_number": "970-384-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 BLAKE AVE",
            "address_2": "STE 206",
            "city": "GLENWOOD SPRINGS",
            "state": "CO",
            "postal_code": "816014227",
            "telephone_number": "970-384-7140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "IZAAK",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2015-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "PA-2255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36780758",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenwood Springs, CO

Sources for this page

Verify at the official NPI Registry.