Individual provider Active NPI

Jennifer Rebecca Reavis, MD

  • Otolaryngology Physician
  • Colorado Springs, CO
National Provider Identifier
1013101146
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
52375 Issued in CO
Practice address
595 Chapel Hills Dr Ste 325
Colorado Springs, CO 80920-1061
Phone
(719) 364-4120
NPI assigned
Aug 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 52375 CO Primary

Addresses

Primary practice location

595 Chapel Hills Dr Ste 325
Colorado Springs, CO 80920-1061

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (970) 624-4123

Other practice location 1

1633 Medical Center Point
Colorado Springs, CO 80907
Phone (719) 635-5148

Other identifiers 1

IdentifierTypeStateIssuer
71951776MedicaidCO

Other names 1

  • Dr. Jennifer Rebecca Decker 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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131226000517 CO Practitioner - Otolaryngology 2961639703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Duke University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1400 E Boulder
Suite 2410 Pre Procedure Memorial
Colorado Springs, CO 80909-5533
Phone (719) 365-6525

1400 E Boulder St
Colorado Springs, CO 80909-5533

4050 Briargate Pkwy
Colorado Springs, CO 80920-7815

4080 Briargate Pkwy
Colorado Springs, CO 80920-7815
Phone (719) 365-6800

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

  • Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
52375COMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Aug 13, 2018 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Aug 13, 2018 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

595 Chapel Hills Dr
Ste 240
Colorado Springs, CO 80920
Phone (719) 364-4120

3843 Rio Vista Dr
Ste 2200
Colorado Springs, CO 80917
Phone (719) 364-4120

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

595 Chapel Hills Dr
Ste 325
Colorado Springs, CO 80920
Phone (719) 364-4120

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

16222 W US Highway 24
Ste 210
Woodland Park, CO 80863
Phone (719) 686-2832

16222 W US Highway 24
Ste 220
Woodland Park, CO 80863
Phone (719) 365-7300

Organizations & group practices 2

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1013101146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-624-4123",
            "fax_number": "970-624-2416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 CHAPEL HILLS DR STE 325",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809201061",
            "telephone_number": "719-364-4120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1633 Medical Center Point",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "80907",
            "country_code": "US",
            "telephone_number": "719-635-5148",
            "fax_number": "719-448-0164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REAVIS",
        "first_name": "JENNIFER",
        "middle_name": "REBECCA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-31",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CO",
            "license": "52375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71951776",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DECKER",
            "middle_name": "REBECCA",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.