NPIMap

Individual provider Active NPI

Michelle L Fussnecker, PA-C

  • Medical Physician Assistant
  • Broomfield, CO
National Provider Identifier
1871047753
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.0004945 Issued in CO
Practice address
6450 W 120TH Ave Unit a
Broomfield, CO 80020
Phone
(720) 274-9200
NPI assigned
Aug 9, 2016
Last updated
Jun 21, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 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 PA2016-0060 NM
Medical Physician Assistant 363AM0700X PA.0004945 CO Primary

Addresses

Primary practice location

6450 W 120TH Ave Unit a
Broomfield, CO 80020

Mailing address

1621 S Wolcott CT
Denver, CO 80219-4334
Phone (720) 530-6404

Other practice location 1

4304 Carlisle Blvd NE
Albuquerque, NM 87107-4811
Phone (505) 888-1075

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
I20170627001767 CO Practitioner - Physician Assistant 2365721453 Reassigns benefits to 2 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
Frontier Neurology and Neuromuscular Clinic PLLCGroup PAC ID 7012045883, 2 clinicians

Practice addresses (Care Compare)

4251 Kipling St
Unit 220
Wheat Ridge, CO 80033-2897
Phone (303) 424-0559

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wild Magnolia Wellness Past Accepting new patients

Organizations & group practices 3

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 10

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": "1470700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529539200000",
    "number": "1871047753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 S WOLCOTT CT",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802194334",
            "telephone_number": "720-530-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6450 W 120TH AVE UNIT A",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "80020",
            "telephone_number": "720-274-9200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4304 Carlisle Blvd NE",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871074811",
            "country_code": "US",
            "telephone_number": "505-888-1075",
            "fax_number": "505-888-1082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUSSNECKER",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-09",
        "last_updated": "2018-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA2016-0060",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0004945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomfield, CO

Sources for this page

Verify at the official NPI Registry.