NPIMap

Individual provider Active NPI

Teryn Mori, PA-C

  • Physician Assistant
  • Boulder, CO
National Provider Identifier
1164025292
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0006803 Issued in CO
Practice address
4740 Pearl Pkwy Ste 200
Boulder, CO 80301-3080
Phone
(303) 449-2730
NPI assigned
Nov 20, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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 PA.0006803 CO Primary

Addresses

Primary practice location

4740 Pearl Pkwy Ste 200
Boulder, CO 80301-3080

Mailing address

154 Colley Ave
Norfolk, VA 23510-1007
Phone (757) 446-7158

Other practice location 1

154 Colley Ave
Norfolk, VA 23510-1007
Phone (757) 446-7158

Other names 1

  • Teryn Weidemann Former 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
I20211001000531 CO Practitioner - Physician Assistant 6002214293 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
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) 810-4121

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

2555 E 13TH St
Suite 105
Loveland, CO 80537-5134
Phone (970) 820-6300

2964 Ginnala Dr
Loveland, CO 80538-2701
Phone (970) 667-7755

4700 Lady Moon Dr
Fort Collins, CO 80528-4426

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince Jun 9, 2025 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Jun 9, 2025 Accepting new patients
Bouldercentre for Orthopedics PastSince Feb 11, 2024 Accepting new patients

Locations

2001 70th Ave
Ste 110
Greeley, CO 80634
Phone (970) 378-4155

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

2555 E 13th St
Ste 110
Loveland, CO 80537
Phone (970) 461-6140

1017 W 7th St
Wray, CO 80758
Phone (970) 332-4811

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/3497/brand/1/csg/21/fhir/r4

Organizations & group practices 6

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 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": "1605830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1164025292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 COLLEY AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235101007",
            "telephone_number": "757-446-7158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 PEARL PKWY STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803013080",
            "telephone_number": "303-449-2730"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "154 Colley Ave",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235101007",
            "country_code": "US",
            "telephone_number": "757-446-7158",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORI",
        "first_name": "TERYN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-20",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0006803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERYN",
            "last_name": "WEIDEMANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.