Active NPI
Jenna Michal Kanner
- Student in an Organized Health Care Education/Training Program
- Aurora, CO
National Provider Identifier
1144921008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 12631 E 17TH Ave Ste F496
Aurora, CO 80045-2527 - Phone
- (303) 724-9700
- NPI assigned
- Mar 16, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | DR.0078064 | CO | |
| Student in an Organized Health Care Education/Training Program | 390200000X | CO | Primary |
Addresses
Primary practice location
12631 E 17TH Ave Ste F496
Aurora, CO 80045-2527
Mailing address
12631 E 17TH Ave Ste F496
Aurora, CO 80045-2527
Phone (303) 724-9700
Other practice location 1
655 W Baltimore St
Baltimore, MD 21201-1509
Phone (410) 706-3100
Other practice location 2
10350 E Dakota Ave
Denver, CO 80247-1314
Phone (303) 338-4545
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9000231359 | Medicaid | CO |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240702001458 | CO | Order and Referring Only - Family Practice | 9335683267 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787011200000",
"number": "1144921008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12631 E 17TH AVE STE F496",
"city": "AURORA",
"state": "CO",
"postal_code": "800452527",
"telephone_number": "303-724-9700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12631 E 17TH AVE STE F496",
"city": "AURORA",
"state": "CO",
"postal_code": "800452527",
"telephone_number": "303-724-9700"
}
],
"practiceLocations": [
{
"address_1": "655 W Baltimore St",
"address_purpose": "LOCATION",
"city": "Baltimore",
"state": "MD",
"postal_code": "212011509",
"country_code": "US",
"telephone_number": "410-706-3100",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "10350 E Dakota Ave",
"address_purpose": "LOCATION",
"city": "Denver",
"state": "CO",
"postal_code": "802471314",
"country_code": "US",
"telephone_number": "303-338-4545",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KANNER",
"first_name": "JENNA",
"middle_name": "MICHAL",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-16",
"last_updated": "2026-08-18",
"certification_date": "2026-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "DR.0078064",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CO",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9000231359",
"state": "CO"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
"affiliation": "N",
"endpointDescription": "Carequality",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "10350 E Dakota Ave",
"city": "Denver",
"state": "CO",
"country_code": "US",
"postal_code": "802471314",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.