NPIMap

Individual provider Active NPI

Jeffrey R Bundy, P.A.

  • Physician Assistant
  • Fort Collins, CO
National Provider Identifier
1952494767
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1530 Issued in CO
Practice address
3519 Richmond Dr
Fort Collins, CO 80526-5995
Phone
(970) 204-0300
Fax
(970) 493-6868
NPI assigned
Oct 2, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 1530 CO Primary

Addresses

Primary practice location

3519 Richmond Dr
Fort Collins, CO 80526-5995

Mailing address

3519 Richmond Dr
Fort Collins, CO 80526-5995
Phone (970) 204-0300

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
I20101119000165 CO Practitioner - Physician Assistant 7618163452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alpine Ear Nose and Throat PCGroup PAC ID 9436127032, 25 clinicians

Practice addresses (Care Compare)

1120 E Elizabeth St
Fort Collins, CO 80524-4044
Phone (970) 221-1177

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1530COMDClinical Psychologist

Organizations & group practices 1

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952494767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3519 RICHMOND DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805265995",
            "telephone_number": "970-204-0300",
            "fax_number": "970-493-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3519 RICHMOND DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805265995",
            "telephone_number": "970-204-0300",
            "fax_number": "970-493-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNDY",
        "first_name": "JEFFREY",
        "middle_name": "R",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "1530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.