NPIMap

Individual provider Active NPI

Michaela Paige Sullivan, PA-C

  • Physician Assistant
  • Loveland, CO
National Provider Identifier
1982308193
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1708 Boise Ave
Loveland, CO 80538-4204
Phone
(970) 667-3116
Fax
(970) 669-0159
NPI assigned
Mar 30, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

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 Primary

Addresses

Primary practice location

1708 Boise Ave
Loveland, CO 80538-4204

Mailing address

1708 Boise Ave
Loveland, CO 80538-4204
Phone (970) 667-3116

Other practice location 1

13001 E 17th Place
Room E7019, Mail stop F543
Aurora, CO 80045
Phone (303) 724-7963

Other names 1

  • Michaela Paige Sulek 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
I20231004001646 CO Practitioner - Physician Assistant 4486008877 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Loveland Dermatology PCGroup PAC ID 1456329655, 5 clinicians
Skin PCGroup PAC ID 5395046247, 4 clinicians

Practice addresses (Care Compare)

1708 Boise Ave
Loveland, CO 80538-4204
Phone (970) 667-3116

905 Alpine Ave
Boulder, CO 80304-3305
Phone (970) 667-3116

Hospital & facility affiliations

  • Boulder Community Health Hospital, Boulder, CO, CCN 060027

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Loveland Dermatology PC CurrentSince Aug 20, 2023 Accepting new patients
Lake Loveland Dermatology PC CurrentSince Aug 20, 2023 Accepting new patients
Ingerlisa Mattoch MD Inc Current Accepting new patients
Skin PC Past Accepting new patients

Locations

1101 Oakridge Dr
Fort Collins, CO 80525
Phone (970) 207-9773

1708 Boise Ave
Loveland, CO 80538
Phone (970) 663-0815

1405 S 8th Ave
Ste 102
Sterling, CO 80751
Phone (970) 522-0591

1683 Main St
Windsor, CO 80550
Phone (970) 400-7618

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 and National Provider Directory roles.

Hospital & facility affiliations 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1680134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1982308193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1708 BOISE AVE",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805384204",
            "telephone_number": "970-667-3116",
            "fax_number": "970-669-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 BOISE AVE",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805384204",
            "telephone_number": "970-667-3116",
            "fax_number": "970-669-0159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13001 E 17th Place",
            "address_2": "Room E7019, Mail stop F543",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "80045",
            "country_code": "US",
            "telephone_number": "303-724-7963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MICHAELA",
        "middle_name": "PAIGE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-30",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAELA",
            "last_name": "SULEK",
            "middle_name": "PAIGE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.