NPIMap

Organization Active NPI

Jefferson Center for Mental Health

  • Pharmacy
  • Wheat Ridge, CO
National Provider Identifier
1013373679
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
1680000103 Issued in CO
Legal business name
JEFFERSON CENTER FOR MENTAL HEALTH
Practice address
4851 Independence St
Wheat Ridge, CO 80033-6715
Phone
(303) 432-5725
Fax
(303) 432-5724
NPI assigned
Jan 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

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

Authorized official

Name
Mr. Andrew Vander Kooi, PHARMD
Title
Director of Pharmacy
Phone
(303) 432-5725

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 1680000103 CO Primary
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

4851 Independence St
Wheat Ridge, CO 80033-6715

Mailing address

4851 Independence St
Wheat Ridge, CO 80033-6715
Phone (303) 432-5725

Other identifiers 2

IdentifierTypeStateIssuer
04680057MedicaidCO
2157466OtherPK

Other names 1

  • Blue Spruce Pharmacy at Independence Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210416000164 CO Part B Supplier - Mass Immunization (Roster Biller Only) 9032018882 1 other NPI on this enrollment
Practice locations: Lakewood, CO; Wheat Ridge, CO

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Ctr Mental Health57 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Interoperability endpoints

  • FHIR API: https://fhir.netsmartcloud.com/uscore/v1/

NPI Registry JSON

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

{
    "created_epoch": "1452556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760918400000",
    "number": "1013373679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4851 INDEPENDENCE ST",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336715",
            "telephone_number": "303-432-5725",
            "fax_number": "303-432-5724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4851 INDEPENDENCE ST",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336715",
            "telephone_number": "303-432-5725",
            "fax_number": "303-432-5724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON CENTER FOR MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-12",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A",
        "authorized_official_last_name": "VANDER KOOI",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "303-432-5725",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CO",
            "license": "1680000103",
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04680057",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2157466",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Spruce Pharmacy at Independence",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blue Spruce Pharmacy at Independence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wheat Ridge, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.