Pediatric Associates Prof LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PEDIATRIC ASSOCIATES PROF LLC

Practice address

242 Cottonwood St Ste 101
Delta, CO 81416-4404

Phone

(970) 874-7552

Fax

(970) 874-7554

NPI assigned

Mar 27, 2018

Organization subpart

Yes

Parent organization

PEDIATRIC ASSOCIATES PROF LLCAs reported in NPPES

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

Authorized official

Name

Amber Hickert

Title

Practice Administrator

Phone

(970) 249-2421

Specialties & licenses 1

Addresses

Other names 1

• Delta Office Pediatric Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Rural health clinic certification: CCN 068900

Legal name

PEDIATRIC ASSOCIATES PROF LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Sep 5, 2024

Last certification

Sep 5, 2024

Ownership / control type

1C

Organization structure

PartnershipProprietary

Incorporated

Dec 1, 2004 in CO

Enrollment address

242 Cottonwood St
Ste 101
Delta, CO 81416-4404

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Pediatric Associates Prof LLC

  • Rural Health Clinic/Center
  • Delta, CO
  • NPI 1043016124

  O20240223002210

  Same enrollment

Part of

Etzenhouser Kei

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Pediatric Associates Prof LLC

  • Pediatrics Physician
  • Montrose, CO
  • NPI 1548261324
  NPPES parent name

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

{
    "created_epoch": "1522108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1831694231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "947 S 5TH ST",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814015716",
            "telephone_number": "970-249-2421",
            "fax_number": "970-249-1203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 COTTONWOOD ST STE 101",
            "city": "DELTA",
            "state": "CO",
            "postal_code": "814164404",
            "telephone_number": "970-874-7552",
            "fax_number": "970-874-7554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "910 S 4th St",
            "address_purpose": "LOCATION",
            "city": "Montrose",
            "state": "CO",
            "postal_code": "814014226",
            "country_code": "US",
            "telephone_number": "970-249-2421",
            "fax_number": "970-249-1203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "947 S 5th St",
            "address_purpose": "LOCATION",
            "city": "Montrose",
            "state": "CO",
            "postal_code": "814015716",
            "country_code": "US",
            "telephone_number": "970-249-2421",
            "fax_number": "970-249-1203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES PROF LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC ASSOCIATES PROF LLC",
        "enumeration_date": "2018-03-27",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "HICKERT",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "970-249-2421"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Office Pediatric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel K Paradis, PT & OWNER
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• Nicole A Pech
• Pediatric Associates Prof LLC
• Pediatric Psychology Services of Colorado
• Alexis Louise Pennel
• Peoplecare of Western Colorado
• Peoplecare of Western Colorado, LLC
• Christina May Peters

• Pediatrics Physician in Delta, CO
• Providers in Delta, CO by specialty
• Pediatrics Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.