NPIMap

Individual provider Active NPI

Jaclyn Heinze Summers, PA-C

  • Physician Assistant
  • Greeley, CO
National Provider Identifier
1073876777
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3456 Issued in CO
Practice address
1801 16TH St
Greeley, CO 80631
Phone
(970) 810-3894
Fax
(970) 810-3897
NPI assigned
Jun 19, 2012
Last updated
Feb 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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 3456 CO Primary

Addresses

Primary practice location

1801 16TH St
Greeley, CO 80631

Mailing address

1801 16TH St
Greeley, CO 80631
Phone (970) 810-3894

Other names 1

  • Jackie Summers Other 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
I20130918000256 CO Practitioner - Physician Assistant 4385880681 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy of West Denver Limited PartnershipGroup PAC ID 6709771157, shared by 5 NPIs, 530 clinicians

Practice addresses (Care Compare)

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4593

2000 Boise Ave
Loveland, CO 80538-5006
Phone (970) 820-4640

8601 Turnpike Dr
Suite 204
Westminster, CO 80031-7043
Phone (303) 222-4312

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3456COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Aug 1, 2019 Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Aug 1, 2019 Accepting new patients
Banner Hospital Based Physicians Colorado LLC Past Accepting new patients
Big Thompson Medical Group Inc Physician Assistant Past Accepting new patients

Locations

4700 Lady Moon Dr
Ste C1
Fort Collins, CO 80528
Phone (970) 821-4500

4700 Lady Moon Dr
Ste C2
Fort Collins, CO 80528
Phone (970) 810-5996

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1073876777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 16TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "80631",
            "telephone_number": "970-810-3894",
            "fax_number": "970-810-3897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 16TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "80631",
            "telephone_number": "970-810-3894",
            "fax_number": "970-810-3897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERS",
        "first_name": "JACLYN",
        "middle_name": "HEINZE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-19",
        "last_updated": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "3456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "SUMMERS",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greeley, CO

Sources for this page

Verify at the official NPI Registry.