NPIMap

Individual provider Active NPI

Sophia Wagner Burge, PA-C

  • Surgical Physician Assistant
  • Greeley, CO
National Provider Identifier
1972026276
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA.0005117 Issued in CO
Practice address
1800 15TH St Ste 340
Greeley, CO 80631-4562
Phone
(970) 810-4593
Fax
(970) 810-4591
NPI assigned
Jul 19, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X
Surgical Physician Assistant 363AS0400X PA.0005117 CO Primary

Addresses

Primary practice location

1800 15TH St Ste 340
Greeley, CO 80631-4562

Mailing address

1800 15TH St Ste 340
Greeley, CO 80631-4562
Phone (970) 810-4593

Other names 1

  • Miss Sophia Jane Wagner 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
I20171003004196 CO Practitioner - Physician Assistant 8729353693 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner Health Physicians Colorado LLCGroup PAC ID 8921273038, 278 clinicians

Practice addresses (Care Compare)

1800 15TH St
Greeley, CO 80631-4562

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4121

4700 Lady Moon Dr
Fort Collins, CO 80528-4426

Hospital & facility affiliations

  • Banner North Colorado Medical Center Hospital, Greeley, CO, CCN 060001
  • East Morgan County Hospital Hospital, Brush, CO, CCN 061303
  • Sterling Regional Medcenter Hospital, Sterling, CO, CCN 060076

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince Nov 29, 2020 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Nov 29, 2020 Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Jul 22, 2019 Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Jul 22, 2019 Accepting new patients
St Mary'S Hospital and Medical Center, Inc Past Accepting new patients

Locations

1800 15th St
Ste 340
Greeley, CO 80631
Phone (970) 351-6044

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

Organizations & group practices 6

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1500422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1972026276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 15TH ST STE 340",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806314562",
            "telephone_number": "970-810-4593",
            "fax_number": "970-810-4591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 15TH ST STE 340",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806314562",
            "telephone_number": "970-810-4593",
            "fax_number": "970-810-4591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGE",
        "first_name": "SOPHIA",
        "middle_name": "WAGNER",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-19",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "PA.0005117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SOPHIA",
            "last_name": "WAGNER",
            "middle_name": "JANE",
            "prefix": "MISS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Greeley, CO

Sources for this page

Verify at the official NPI Registry.