Individual provider Active NPI

Jacob A. Weirich, PA-C

  • Physician Assistant
  • Grand Junction, CO
National Provider Identifier
1174925309
Registry record updated May 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0004273 Issued in CO
Practice address
2635 N 7TH St
Grand Junction, CO 81501
Phone
(970) 298-2551
NPI assigned
Sep 18, 2014
Last updated
May 10, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5823 AZ
Physician Assistant 363A00000X PA.0004273 CO Primary

Addresses

Primary practice location

2635 N 7TH St
Grand Junction, CO 81501

Mailing address

2635 N 7TH St
Grand Junction, CO 81501-8209
Phone (970) 298-2551

Other practice location 1

569 32 Road
Unit 12
Grand Junction, CO 81504-6095
Phone (970) 523-3544

Other practice location 2

569 32 Road
Unit 12
Grand Junction, CO 81504-6095
Phone (970) 523-3544

Other identifiers 2

IdentifierTypeStateIssuer
553172YYS0OtherCOMEDICARE B FOR MOUNTAIN PEAKS URGENT CARE
22506080MedicaidCO

Other names 1

  • Jacob Weirich Professional name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150623002838 CO Practitioner - Physician Assistant 6103149620 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
98.63 of 100Reported as group
Quality
97.27
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5823AZMDPhysician Assistant
PA.0004273COMDPhysician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557446400000",
    "number": "1174925309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2635 N 7TH ST",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018209",
            "telephone_number": "970-298-2551",
            "fax_number": "970-298-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 N 7TH ST",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "81501",
            "telephone_number": "970-298-2551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "569 32 Road",
            "address_2": "Unit 12",
            "address_purpose": "LOCATION",
            "city": "Grand Junction",
            "state": "CO",
            "postal_code": "815046095",
            "country_code": "US",
            "telephone_number": "970-523-3544",
            "fax_number": "970-434-3422",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "569 32 Road",
            "address_2": "Unit 12",
            "address_purpose": "LOCATION",
            "city": "Grand Junction",
            "state": "CO",
            "postal_code": "815046095",
            "country_code": "US",
            "telephone_number": "970-523-3544",
            "fax_number": "970-434-3422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEIRICH",
        "first_name": "JACOB",
        "middle_name": "A.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-18",
        "last_updated": "2019-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5823",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE B FOR MOUNTAIN PEAKS URGENT CARE",
            "identifier": "553172YYS0",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22506080",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACOB",
            "last_name": "WEIRICH",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Grand Junction, CO

Sources for this page

Verify at the official NPI Registry.