Individual provider Active NPI

Deborah M. Tong, P.A.

  • Physician Assistant
  • Wheat Ridge, CO
National Provider Identifier
1992846331
Registry record updated Nov 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0001454 Issued in CO
Practice address
7495 W 29TH Ave
Wheat Ridge, CO 80033-8002
Phone
(303) 239-9964
Fax
(303) 237-4343
NPI assigned
Feb 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2017

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 PA.0001454 CO Primary

Addresses

Primary practice location

7495 W 29TH Ave
Wheat Ridge, CO 80033-8002

Mailing address

3701 S Broadway
Englewood, CO 80113-3611
Phone (303) 761-1977

Other identifiers 1

IdentifierTypeStateIssuer
19671334MedicaidCO

Other names 1

  • Deborah M. McCullough Former name

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
I20150303001818 CO Order and Referring Only - Physician Assistant 1456677707

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0001454COMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509926400000",
    "number": "1992846331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 S BROADWAY",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801133611",
            "telephone_number": "303-761-1977",
            "fax_number": "303-761-2787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7495 W 29TH AVE",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800338002",
            "telephone_number": "303-239-9964",
            "fax_number": "303-237-4343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TONG",
        "first_name": "DEBORAH",
        "middle_name": "M.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2017-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0001454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19671334",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBORAH",
            "last_name": "MCCULLOUGH",
            "middle_name": "M.",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wheat Ridge, CO

Sources for this page

Verify at the official NPI Registry.