Active NPI
Mako Shimoda, MD
- Obstetrics & Gynecology Physician
- Boulder, CO
National Provider Identifier
1851352330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 36257
- Practice address
- 4745 Arapahoe Avenue
Suite 320
Boulder, CO 80303 - Phone
- (303) 441-0587
- Fax
- (303) 996-0801
- NPI assigned
- Apr 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 36257 | CO | Primary |
Addresses
Primary practice location
4745 Arapahoe Avenue
Suite 320
Boulder, CO 80303
Mailing address
4745 Arapahoe Avenue
Suite 320
Boulder, CO 80303
Phone (303) 441-0587
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 55404251 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36257 | CO | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283817600000",
"number": "1851352330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4745 ARAPAHOE AVENUE",
"address_2": "SUITE 320",
"city": "BOULDER",
"state": "CO",
"postal_code": "80303",
"telephone_number": "303-441-0587",
"fax_number": "303-996-0801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4745 ARAPAHOE AVENUE",
"address_2": "SUITE 320",
"city": "BOULDER",
"state": "CO",
"postal_code": "80303",
"telephone_number": "303-441-0587",
"fax_number": "303-996-0801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIMODA",
"first_name": "MAKO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-01",
"last_updated": "2010-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "CO",
"license": "36257",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "55404251",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.