Individual provider Active NPI

Ruth Ellen Davis, PA

  • Physician Assistant
  • Golden, CO
National Provider Identifier
1962416065
Registry record updated Jan 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2141 Issued in CO
Practice address
5920 McIntyre St
Golden, CO 80403-7445
Phone
(303) 949-1250
NPI assigned
Jul 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2016

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 2141 CO Primary

Addresses

Primary practice location

5920 McIntyre St
Golden, CO 80403-7445

Mailing address

5920 McIntyre St
Golden, CO 80403-7445
Phone (303) 949-1250

Other identifiers 1

IdentifierTypeStateIssuer
32007779MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060420000135 CO Practitioner - Physician Assistant 8224047139 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2141COMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Inpatient Consultants of Colorado, PC Physician Assistant Past Accepting new patients
Inpatient Consultants of Colorado PC Past Accepting new patients
Senior Care of Colorado, PC Physician Assistant PastSince Sep 1, 2010 Accepting new patients
Flatirons Family Practice Inc PastSince Jan 9, 2011 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453334400000",
    "number": "1962416065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 MCINTYRE ST",
            "city": "GOLDEN",
            "state": "CO",
            "postal_code": "804037445",
            "telephone_number": "303-949-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5920 MCINTYRE ST",
            "city": "GOLDEN",
            "state": "CO",
            "postal_code": "804037445",
            "telephone_number": "303-949-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "RUTH",
        "middle_name": "ELLEN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2016-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "2141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32007779",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Golden, CO

Sources for this page

Verify at the official NPI Registry.