NPIMap

Individual provider Active NPI

Kathryn L Olsen, PA

  • Physician Assistant
  • Loveland, CO
National Provider Identifier
1902889124
Registry record updated Nov 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2133 Issued in CO
Practice address
1708 Boise Ave
Loveland, CO 80538-4204
Phone
(970) 667-3116
Fax
(970) 669-0159
NPI assigned
Nov 22, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2133 CO Primary

Addresses

Primary practice location

1708 Boise Ave
Loveland, CO 80538-4204

Mailing address

PO Box 7643
Loveland, CO 80537-0643
Phone (970) 667-3116

Other identifiers 1

IdentifierTypeStateIssuer
14708876MedicaidCO

Other names 1

  • Kathryn Knoche Former 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
I20051031000959 CO Practitioner - Physician Assistant 1355368127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Iowa, RJ & L Carver College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Loveland Dermatology PCGroup PAC ID 1456329655, 5 clinicians

Practice addresses (Care Compare)

1708 Boise Ave
Loveland, CO 80538-4204
Phone (970) 667-3116

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2133COMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ingerlisa Mattoch MD Inc Current Accepting new patients
Lake Loveland Dermatology PC CurrentSince Jun 6, 2013 Accepting new patients
Lake Loveland Dermatology PC CurrentSince Jun 6, 2013 Accepting new patients
Big Thompson Medical Group Inc Physician Assistant Past Accepting new patients

Locations

1101 Oakridge Dr
Fort Collins, CO 80525
Phone (970) 207-9773

1708 Boise Ave
Loveland, CO 80538
Phone (970) 663-0815

776 W Eisenhower Blvd
Loveland, CO 80537
Phone 3034426647309

1405 S 8th Ave
Ste 102
Sterling, CO 80751
Phone (970) 522-0591

1683 Main St
Windsor, CO 80550
Phone (970) 400-7618

Organizations & group practices 5

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1902889124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7643",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805370643",
            "telephone_number": "970-667-3116",
            "fax_number": "970-669-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 BOISE AVE",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805384204",
            "telephone_number": "970-667-3116",
            "fax_number": "970-669-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "KATHRYN",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-22",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "2133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14708876",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "KNOCHE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.