Individual provider Active NPI

Yuri C Rothbaum, PA

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1831122068
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0001060 Issued in CO
Practice address
1400 E Boulder St
Colorado Springs, CO 80909
Phone
(719) 560-5656
Fax
(719) 560-4715
NPI assigned
Jul 9, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 PA.0001060 CO Primary
Emergency Medicine Physician 207P00000X PA.0001060 CO

Addresses

Primary practice location

1400 E Boulder St
Colorado Springs, CO 80909

Mailing address

PO Box 173891
Denver, CO 80217-3891
Phone (719) 365-5000

Other practice location 1

16420 W US Highway 24
Woodland Park, CO 80863-8760
Phone (719) 687-9999

Other identifiers 3

IdentifierTypeStateIssuer
1060OtherCOCOLORADO LICENSE
P00065901OtherRAILROAD MEDICARE
35288876MedicaidCO

Other names 1

  • Yuri C Rothbaum Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20120425000508 CO Practitioner - Physician Assistant 8325200033 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
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)

3676 Parker Blvd
Pueblo, CO 81008-2213

3676 Parker Blvd
Suite 390
Pueblo, CO 81008-2215
Phone (719) 595-7780

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4921

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
PA.0001060COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jun 1, 2025 Accepting new patients
Usacs of Colorado Inc Emergency Medicine CurrentSince Jun 6, 2018 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jun 1, 2025 Accepting new patients
Usacs Observation Medicine Services of Colorado Inc. CurrentSince Jun 6, 2018 Accepting new patients
Usacs Observation Medicine Services of Colorado, Inc Emergency Medicine CurrentSince Jun 6, 2018 Accepting new patients
Usacs of Colorado Inc Emergency Medicine CurrentSince Jun 6, 2018 Accepting new patients

Locations

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

1400 E Boulder St
Colorado Springs, CO 80909
Phone (719) 365-5120

2222 N Nevada Ave
Colorado Springs, CO 80907
Phone (719) 776-5333

4050 Briargate Pkwy
Colorado Springs, CO 80920
Phone (719) 364-5000

11600 W 2nd Pl
Lakewood, CO 80228
Phone (720) 321-1010

7700 S Broadway
Littleton, CO 80122
Phone (303) 269-4786

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

1008 Minnequa Ave
Pueblo, CO 81004
Phone (719) 557-5656

1619 N Greenwood St
Ste 106
Pueblo, CO 81003
Phone (719) 595-7760

3676 Parker Blvd
Ste 390
Pueblo, CO 81008
Phone (719) 595-7780

16420 W US Highway 24
Woodland Park, CO 80863
Phone (719) 632-5020

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1831122068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 173891",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802173891",
            "telephone_number": "719-365-5000",
            "fax_number": "719-365-6827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E BOULDER ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80909",
            "telephone_number": "719-560-5656",
            "fax_number": "719-560-4715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16420 W US Highway 24",
            "address_purpose": "LOCATION",
            "city": "Woodland Park",
            "state": "CO",
            "postal_code": "808638760",
            "country_code": "US",
            "telephone_number": "719-687-9999",
            "fax_number": "303-306-7753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROTHBAUM",
        "first_name": "YURI",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0001060",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "PA.0001060",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO LICENSE",
            "identifier": "1060",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00065901",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35288876",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "YURI",
            "last_name": "ROTHBAUM",
            "middle_name": "C",
            "credential": "PA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.