Active NPI
Stephen D Bast, PA-C
- Physician Assistant
- Pueblo, CO
National Provider Identifier
1922001700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA.0004346
- Practice address
- 3676 Parker Blvd
Pueblo, CO 81008-2212 - Phone
- (719) 553-2208
- Fax
- (719) 553-2223
- NPI assigned
- May 24, 2005
- Last updated
- Jan 18, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA.0004346 | CO | Primary |
Addresses
Primary practice location
3676 Parker Blvd
Pueblo, CO 81008-2212
Mailing address
PO Box 9000
Pueblo, CO 81008-9000
Phone (719) 553-2208
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08431701 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA.0004346 | CO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453075200000",
"number": "1922001700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9000",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810089000",
"telephone_number": "719-553-2208",
"fax_number": "719-553-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3676 PARKER BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082212",
"telephone_number": "719-553-2208",
"fax_number": "719-553-2223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAST",
"first_name": "STEPHEN",
"middle_name": "D",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2016-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "PA.0004346",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "08431701",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.