Active NPI
Jed Jitsugo Tatsuyama, MD
- Family Medicine Physician
- Pueblo, CO
National Provider Identifier
1114960192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 41404
- Practice address
- 1619 N Greenwood St
Suite 200
Pueblo, CO 81003-2644 - Phone
- (719) 543-1130
- Fax
- (719) 561-2764
- NPI assigned
- Jun 14, 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 41404 | CO | Primary |
Addresses
Primary practice location
1619 N Greenwood St
Suite 200
Pueblo, CO 81003-2644
Mailing address
1619 N Greenwood Street
Suite 200
Pueblo, CO 81003
Phone (719) 543-1130
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62287338 | Medicaid | CO |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209513600000",
"number": "1114960192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1619 N GREENWOOD STREET",
"address_2": "SUITE 200",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81003",
"telephone_number": "719-543-1130",
"fax_number": "719-561-2764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1619 N GREENWOOD ST",
"address_2": "SUITE 200",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810032644",
"telephone_number": "719-543-1130",
"fax_number": "719-561-2764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATSUYAMA",
"first_name": "JED",
"middle_name": "JITSUGO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2008-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "41404",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "62287338",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.