Active NPI
Jerome C Sutherland, M.D.
- Diagnostic Radiology Physician
- Englewood, CO
National Provider Identifier
1023064706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 14605
- Practice address
- 500 E Hampden Ave
Englewood, CO 80113-2703 - Phone
- (303) 761-9190
- NPI assigned
- May 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 14605 | CO | Primary |
Addresses
Primary practice location
500 E Hampden Ave
Englewood, CO 80113-2703
Mailing address
10700 E Geddes Ave
No 200
Englewood, CO 80112-3800
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2315994 | Medicaid | LA | |
| 01146059 | Medicaid | CO | |
| 84-059792913 | Medicaid | NE | |
| 1023064706 | Medicaid | CA | |
| 104686392 | Medicaid | MI | |
| 1023064706 | Medicaid | WY | |
| 200425440A | Medicaid | KS | |
| 99112107 | Medicaid | WI | |
| 053218601 | Medicaid | TX | |
| 920448 | Medicaid | AZ | |
| 300049155 | Other | CO | RR RIA MCRE |
| 300090380 | Other | CO | RR MIC MCRE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14605 | CO | MD | Diagnostic Radiology Physician |
| 29890 | CO | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Radiology Imaging of Nebraska, LLC | Diagnostic Radiology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Diagnostic Radiology Physician
- Scottsbluff, NE
- NPI 1184869901
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360540800000",
"number": "1023064706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10700 E GEDDES AVE",
"address_2": "NO 200",
"city": "ENGLEWOOD",
"state": "CO",
"postal_code": "801123800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 E HAMPDEN AVE",
"city": "ENGLEWOOD",
"state": "CO",
"postal_code": "801132703",
"telephone_number": "303-761-9190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTHERLAND",
"first_name": "JEROME",
"middle_name": "C",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-25",
"last_updated": "2013-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CO",
"license": "14605",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2315994",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01146059",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "84-059792913",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1023064706",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104686392",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1023064706",
"state": "WY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200425440A",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "99112107",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "053218601",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "920448",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR RIA MCRE",
"identifier": "300049155",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MIC MCRE",
"identifier": "300090380",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Englewood, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.