NPIMap

Individual provider Active NPI

Kyle Delong, PA

  • Medical Physician Assistant
  • Grand Junction, CO
National Provider Identifier
1861844292
Registry record updated Dec 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.0004762 Issued in CO
Practice address
2373 G Rd Ste 200
Grand Junction, CO 81505-1006
Phone
(970) 243-3061
Fax
(970) 245-8369
NPI assigned
Jul 11, 2016
Last updated
Dec 31, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Medical Physician Assistant 363AM0700X PA.0004762 CO Primary

Addresses

Primary practice location

2373 G Rd Ste 200
Grand Junction, CO 81505-1006

Mailing address

2373 G Rd Ste 200
Grand Junction, CO 81505-1006
Phone (970) 243-3061

Other identifiers 1

IdentifierTypeStateIssuer
71585036MedicaidCO

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
I20161005002456 CO Practitioner - Physician Assistant 7214225366 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1050 Wellington Ave
Imh Wellington Lung and Sleep Clinic
Grand Junction, CO 81501-8121
Phone (970) 298-5864

2635 N 7TH St
Grand Junction, CO 81501-8209

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0004762COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary's Hospital and Medical Center, Inc Family Medicine CurrentSince Oct 24, 2016 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Sep 23, 2023 Accepting new patients
St Mary's Hospital and Medical Center, Inc CurrentSince Oct 24, 2016 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Sep 23, 2023 Accepting new patients
Colorado Surgical Affiliates, LLC CurrentSince Dec 5, 2018 Accepting new patients
Intermountain Medical Group Grand Junction, LLC PastSince Sep 6, 2020 Accepting new patients

Locations

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

2373 G Rd
Ste 200
Grand Junction, CO 81505
Phone (970) 241-4444

2440 N 11th St
Grand Junction, CO 81501
Phone (970) 243-0900

2635 N 7th St
Grand Junction, CO 81501
Phone (970) 244-2009

2635 N 7th St
#4
Grand Junction, CO 81501
Phone (970) 298-7106

Interoperability endpoints

  • Direct secure messaging: kyledelong@uawc.allscriptsdirect.net

Organizations & group practices 8

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 5

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": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546214400000",
    "number": "1861844292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2373 G RD STE 200",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815051006",
            "telephone_number": "970-243-3061",
            "fax_number": "970-245-8369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 G RD STE 200",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815051006",
            "telephone_number": "970-243-3061",
            "fax_number": "970-245-8369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELONG",
        "first_name": "KYLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-11",
        "last_updated": "2018-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0004762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71585036",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Junction, CO

Sources for this page

Verify at the official NPI Registry.