Colin R Hickenlooper, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9219 Issued in AZ

Practice address

823 N San Francisco St Ste a
Flagstaff, AZ 86001-3265

Phone

(520) 244-0089

Fax

(520) 244-0089

NPI assigned

May 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN, AZ2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: colin.hickenlooper@1146.chartlogic.direct-ci.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Flagstaff Pain & Treatment Center

  • Pain Medicine (Anesthesiology) Physician
  • Flagstaff, AZ
  • NPI 1073127858

  AZ

  Medicare reassignment
• Leconte Orthopedics, PLLC

  • Orthopaedic Surgery Physician
  • Sevierville, TN
  • NPI 1235552381

  TN

  Medicare reassignment
• Flagstaff Pain and Treatment Center

  • Ambulatory Surgical Clinic/Center
  • Flagstaff, AZ
  • NPI 1568009801
  NPD
• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323
  NPD (past)
• Orthoalaska LLC

  • Rheumatology Physician
  • Anchorage, AK
  • NPI 1265293252
  NPD (past)

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789257600000",
    "number": "1972550192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N SWITZER CANYON DR APT 103",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860014830",
            "telephone_number": "907-538-6776",
            "fax_number": "520-244-0089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 N SAN FRANCISCO ST STE A",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013265",
            "telephone_number": "520-244-0089",
            "fax_number": "520-244-0089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2900 12th Ave N Ste 140W",
            "address_purpose": "LOCATION",
            "city": "Billings",
            "state": "MT",
            "postal_code": "591017507",
            "country_code": "US",
            "telephone_number": "406-237-5050",
            "fax_number": "406-272-3395",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5505 W Chandler Blvd Ste 11",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852263683",
            "country_code": "US",
            "telephone_number": "602-753-4133",
            "fax_number": "520-244-0089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKENLOOPER",
        "first_name": "COLIN",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2026-09-13",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "100369",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AK",
            "license": "PADA547",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "9219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020179",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lloyd George Hershey, DO
• Darren T Herzog, MD
• Hey SLP
• Christina Grampp Hibbert, PSY.D.
• Owen J Hibbert, DDS
• Ladonna Lynn Hickman, M.S. CCC-SLP
• Lindsey Alane Hiebert, M.S., CF-SLP
• Paul Hiette, M.D.
• High Country Lactation Care, Inc
• Highline Eye Care, PLLC

• All providers in Flagstaff, AZ
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2026; 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.