Kaela Mashburn, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA.0007112 Issued in CO

Practice address

95 S Pagosa Blvd
Pagosa Springs, CO 81147-8329

Phone

(970) 731-3700

Fax

(970) 731-0511

NPI assigned

Apr 21, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kaela Leskovar Former name

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kaelaleskovar@psmedicalcenter.cernerdirect.com

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.

• Upper San Juan Health Service District

  • Critical Access Hospital
  • Pagosa Springs, CO
  • NPI 1659523058
  Medicare reassignment NPD

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

{
    "created_epoch": "1618963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1972184877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 S PAGOSA BLVD",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "811478329",
            "telephone_number": "970-731-3700",
            "fax_number": "970-731-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 S PAGOSA BLVD",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "811478329",
            "telephone_number": "970-731-3700",
            "fax_number": "970-731-0511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASHBURN",
        "first_name": "KAELA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-21",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0007112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kaelaleskovar@psmedicalcenter.cernerdirect.com",
            "affiliation": "N",
            "address_1": "95 S Pagosa Blvd",
            "city": "Pagosa Springs",
            "state": "CO",
            "country_code": "US",
            "postal_code": "811478329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KAELA",
            "last_name": "LESKOVAR",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Medical Physician Assistant in Pagosa Springs, CO
• Providers in Pagosa Springs, CO by specialty
• Medical Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.