Active NPI
Pamela Wallace Casson, M.D.
- Pediatrics Physician
- Colorado Springs, CO
National Provider Identifier
1851388367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 41888
- Practice address
- 1465 Kelly Johnson Blvd
Suite 220
Colorado Springs, CO 80920-3955 - Phone
- (719) 265-1050
- Fax
- (719) 265-2503
- NPI assigned
- Sep 29, 2005
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 41888 | CO | Primary |
Addresses
Primary practice location
1465 Kelly Johnson Blvd
Suite 220
Colorado Springs, CO 80920-3955
Mailing address
1465 Kelly Johnson Blvd
Suite 220
Colorado Springs, CO 80920-3955
Phone (719) 265-1050
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85487210 | Medicaid | CO |
Other names 1
- Dr. Pamela Jane Wallace
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41888 | CO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pamela W. Casson, MD, PC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Colorado Springs, CO
- NPI 1477794428
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265846400000",
"number": "1851388367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1465 KELLY JOHNSON BLVD",
"address_2": "SUITE 220",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809203955",
"telephone_number": "719-265-1050",
"fax_number": "719-265-2503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1465 KELLY JOHNSON BLVD",
"address_2": "SUITE 220",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809203955",
"telephone_number": "719-265-1050",
"fax_number": "719-265-2503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASSON",
"first_name": "PAMELA",
"middle_name": "WALLACE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-29",
"last_updated": "2010-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CO",
"license": "41888",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "85487210",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PAMELA",
"last_name": "WALLACE",
"middle_name": "JANE",
"prefix": "DR.",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.