Individual provider Active NPI

Matthew Jaramillo, PHD

  • Psychologist
  • Fort Collins, CO
National Provider Identifier
1154604890
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY.0005188 Issued in CO
Practice address
4856 Innovation Dr
Fort Collins, CO 80525-5539
Phone
(970) 494-4200
Fax
(844) 270-1824
NPI assigned
Sep 20, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY.0005188 CO Primary

Addresses

Primary practice location

4856 Innovation Dr
Fort Collins, CO 80525-5539

Mailing address

4856 Innovation Dr
Fort Collins, CO 80525-5539
Phone (970) 494-4200

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200210001402 CO Practitioner - Clinical Psychologist 1153757257 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY.0005188COMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Summitstone Health Partners CurrentSince Jan 24, 2020 Accepting new patients
Summitstone Health Partners Current Accepting new patients
Brightest and Best LLC Current Accepting new patients
Summitstone Health Partners CurrentSince Jan 24, 2020 Accepting new patients
Longview Behavioral Health Past Accepting new patients
Longview Behavioral Health Past Accepting new patients
Longview Behavioral Health Professional Past Accepting new patients
Summitstone Health Partners Past Accepting new patients
Summitstone Health Partners Past Accepting new patients
Longview Behavioral Health Past Accepting new patients

Locations

4856 Innovation Dr
Ste B
Fort Collins, CO 80525
Phone (970) 397-7815

4856 Innovation Dr
Fort Collins, CO 80525

4102 S Timberline Rd
Fort Collins, CO 80525
Phone (970) 494-5728

2001 S Shields St
Ste G
Fort Collins, CO 80526
Phone (970) 484-4871

1217 Riverside Ave
Fort Collins, CO 80524
Phone (970) 482-7800

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1154604890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4856 INNOVATION DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255539",
            "telephone_number": "970-494-4200",
            "fax_number": "844-270-1824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4856 INNOVATION DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255539",
            "telephone_number": "970-494-4200",
            "fax_number": "844-270-1824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JARAMILLO",
        "first_name": "MATTHEW",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-20",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "PSY.0005188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.