NPIMap

Individual provider Active NPI

Angela Cogburn Paddack, M.D.

  • Otolaryngology Physician
  • Boulder, CO
National Provider Identifier
1871767954
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
E-7983 Issued in AR
Practice address
4745 Arapahoe Ave Ste 200
Boulder, CO 80303-1082
Phone
(303) 440-3073
Fax
(303) 541-0807
NPI assigned
Apr 18, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X E-7983 AR Primary

Addresses

Primary practice location

4745 Arapahoe Ave Ste 200
Boulder, CO 80303-1082

Mailing address

4745 Arapahoe Ave Ste 200
Boulder, CO 80303-1082
Phone (303) 440-3073

Other practice location 1

4301 W Markham St # 543
Little Rock, AR 72205-7101
Phone (501) 686-8000

Other names 1

  • Ms. Angela Claire Cogburn Other name

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
I20141010001777 CO Practitioner - Otolaryngology 3375786999 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Texas Tech University Health Science Center School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boulder Medical Center, PCGroup PAC ID 4183536204, 86 clinicians

Practice addresses (Care Compare)

2750 Broadway St
Boulder, CO 80304-3573
Phone (303) 440-3000

4745 Arapahoe Ave
Suite 200
Boulder, CO 80303-1082
Phone (303) 938-4700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-7983ARMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Medical Center, P.C. CurrentSince Aug 1, 2014 Accepting new patients
Boulder Medical Center, P.C. CurrentSince Aug 1, 2014 Accepting new patients
Boulder Medical Center, P.C. Current Accepting new patients
Medical Center Pharmacy Inc Past Accepting new patients

Locations

4745 Arapahoe Ave
Ste 200
Boulder, CO 80303
Phone (303) 938-4710

2750 Broadway St
Boulder, CO 80304
Phone (303) 440-3000

1551 Professional Ln
Unit 240
Longmont, CO 80501
Phone (303) 938-4710

Organizations & group practices 4

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.

Hospital & facility affiliations 35

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1871767954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4745 ARAPAHOE AVE STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031082",
            "telephone_number": "303-440-3073",
            "fax_number": "303-541-0807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 ARAPAHOE AVE STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031082",
            "telephone_number": "303-440-3073",
            "fax_number": "303-541-0807"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4301 W Markham St # 543",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722057101",
            "country_code": "US",
            "telephone_number": "501-686-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PADDACK",
        "first_name": "ANGELA",
        "middle_name": "COGBURN",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-18",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "AR",
            "license": "E-7983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "COGBURN",
            "middle_name": "CLAIRE",
            "prefix": "MS.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.