NPIMap

Individual provider Active NPI

Egle Asta Bakanauskas, M.D.

  • Family Medicine Physician
  • Windsor, CO
National Provider Identifier
1902950223
Registry record updated Jan 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39763 Issued in CO
Practice address
1455 Main St
Suite 100
Windsor, CO 80550-5559
Phone
(970) 686-3950
Fax
(970) 686-3960
NPI assigned
Jan 23, 2007
Last updated
Jan 19, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39763 CO Primary

Addresses

Primary practice location

1455 Main St
Suite 100
Windsor, CO 80550-5559

Mailing address

1455 Main St
Suite 100
Windsor, CO 80550-5559
Phone (970) 686-3950

Other identifiers 2

IdentifierTypeStateIssuer
P00877649OtherCOMEDICARE RAILROAD CARRIER PTAN
56907311MedicaidCO

Other names 1

  • Egle Asta Zableckas 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
I20060412000757 CO Practitioner - Family Practice 8628087038 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

1455 Main St
Suite 140
Windsor, CO 80550-5559
Phone (970) 686-3950

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

730 14TH St SW
Suite 200
Loveland, CO 80537-6349
Phone (970) 663-0815

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions73
Removal of nail tissue1-10
Removal or shaving of skin growth18
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39763COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Sep 13, 2010 Accepting new patients
Poudre Valley Health Care Inc. Current Accepting new patients
Poudre Valley Health Care,Inc CurrentSince Mar 1, 2016 Accepting new patients
Poudre Valley Health Care Inc CurrentSince Mar 1, 2016 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

1025 Pennock Pl
Fort Collins, CO 80524
Phone (970) 495-8800

1025 Pennock Pl
Ste 114
Fort Collins, CO 80524
Phone (970) 495-8800

2315 E Harmony Rd
Ste 200
Fort Collins, CO 80528

4601 Corbett Dr
Fort Collins, CO 80528
Phone (970) 207-4800

1900 16th St
Greeley, CO 80631
Phone (970) 350-2438

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

1455 Main St
Ste 100
Windsor, CO 80550
Phone (970) 207-4857

1455 Main St
Ste 140
Windsor, CO 80550
Phone (970) 460-9205

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421625600000",
    "number": "1902950223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 MAIN ST",
            "address_2": "SUITE 100",
            "city": "WINDSOR",
            "state": "CO",
            "postal_code": "805505559",
            "telephone_number": "970-686-3950",
            "fax_number": "970-686-3960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 MAIN ST",
            "address_2": "SUITE 100",
            "city": "WINDSOR",
            "state": "CO",
            "postal_code": "805505559",
            "telephone_number": "970-686-3950",
            "fax_number": "970-686-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKANAUSKAS",
        "first_name": "EGLE",
        "middle_name": "ASTA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2015-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "39763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD CARRIER PTAN",
            "identifier": "P00877649",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56907311",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EGLE",
            "last_name": "ZABLECKAS",
            "middle_name": "ASTA",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Windsor, CO

Sources for this page

Verify at the official NPI Registry.