NPIMap

Individual provider Active NPI

Victor Palomares, P.A.

  • Physician Assistant
  • Loveland, CO
National Provider Identifier
1922087238
Registry record updated Jun 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
611 Issued in CO
Practice address
3850 N Grant Ave
Suite 200
Loveland, CO 80538-8431
Phone
(970) 624-5170
Fax
(970) 669-7521
NPI assigned
Jan 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 611 CO
Surgical Physician Assistant 363AS0400X 611 CO
Physician Assistant 363A00000X 611 CO Primary

Addresses

Primary practice location

3850 N Grant Ave
Suite 200
Loveland, CO 80538-8431

Mailing address

3850 N Grant Ave
Suite 200
Loveland, CO 80538-8431
Phone (970) 624-5170

Other identifiers 2

IdentifierTypeStateIssuer
127998000MedicaidWY
11424770MedicaidCO

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
I20041203000294 CO Practitioner - Physician Assistant 4082670880 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
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 of West Denver Limited PartnershipGroup PAC ID 6709771157, shared by 5 NPIs, 530 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

1400 E Boulder
Suite 2410 Pre Procedure Memorial
Colorado Springs, CO 80909-5533
Phone (719) 365-6525

1400 E Boulder St
Colorado Springs, CO 80909-5533

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

221 E 29TH St
Loveland, CO 80538-2746

2964 Ginnala Dr
Loveland, CO 80538-2701
Phone (970) 667-7755

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
611COMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Sep 6, 2010 Accepting new patients

Locations

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

221 E 29th St
Ste 202
Loveland, CO 80538
Phone (970) 203-7050

2975 Ginnala Dr
Ste 120
Loveland, CO 80538
Phone (970) 624-5170

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

3850 Grant Ave
Ste 200
Loveland, CO 80538
Phone (970) 624-5170

221 E 29th St
Ste 102
Loveland, CO 80538
Phone (970) 224-3636

Organizations & group practices 2

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402531200000",
    "number": "1922087238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 N GRANT AVE",
            "address_2": "SUITE 200",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805388431",
            "telephone_number": "970-624-5170",
            "fax_number": "970-669-7521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 N GRANT AVE",
            "address_2": "SUITE 200",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805388431",
            "telephone_number": "970-624-5170",
            "fax_number": "970-669-7521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALOMARES",
        "first_name": "VICTOR",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2014-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "611",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "611",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127998000",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11424770",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.