NPIMap

Individual provider Active NPI

Jacob Edward Blumenfeld, PA-C

  • Surgical Physician Assistant
  • Greenwood Village, CO
National Provider Identifier
1083474936
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA.0008462 Issued in CO
Practice address
5600 S Quebec St Ste 312a
Greenwood Village, CO 80111-2208
Phone
(303) 436-2727
Fax
(303) 436-2710
NPI assigned
Mar 19, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA.0008462 CO Primary

Addresses

Primary practice location

5600 S Quebec St Ste 312a
Greenwood Village, CO 80111-2208

Mailing address

12089 Rockdale St
Parker, CO 80138-8750
Phone (415) 200-7158

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240506001481 CO Practitioner - Physician Assistant 4789024886 Reassigns benefits to 1 organization
I20260501000535 CA Practitioner - Physician Assistant 4789024886 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Rocky Vista University College of Osteopathic Med, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Banner Health Physicians Colorado LLCGroup PAC ID 8921273038, 278 clinicians
Northbay Health Medical FoundationGroup PAC ID 3274010871, 207 clinicians
Northbay Physicians Surgery Center, LLCGroup PAC ID 0042122244, 336 clinicians

Practice addresses (Care Compare)

1800 15TH St
Suite 100B
Greeley, CO 80631-4595
Phone (970) 810-5418

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4121

1860 Pennsylvania Ave
Fairfield, CA 94533-3590
Phone (707) 646-4114

1860 Pennsylvania Ave
Suite 230
Fairfield, CA 94533-3550
Phone (707) 646-4000

Hospital & facility affiliations

  • Banner North Colorado Medical Center Hospital, Greeley, CO, CCN 060001
  • Northbay Medical Center Hospital, Fairfield, CA, CCN 050367
  • Banner North Co Medical Center - Loveland Campus Hospital, Loveland, CO, CCN 060030
  • Sterling Regional Medcenter Hospital, Sterling, CO, CCN 060076

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince May 6, 2024 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince May 6, 2024 Accepting new patients

Locations

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

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

Organizations & group practices 4

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1083474936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12089 ROCKDALE ST",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801388750",
            "telephone_number": "415-200-7158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 S QUEBEC ST STE 312A",
            "city": "GREENWOOD VILLAGE",
            "state": "CO",
            "postal_code": "801112208",
            "telephone_number": "303-436-2727",
            "fax_number": "303-436-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUMENFELD",
        "first_name": "JACOB",
        "middle_name": "EDWARD",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "PA.0008462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood Village, CO

Sources for this page

Verify at the official NPI Registry.