NPIMap

Individual provider Active NPI

Jaclyn Fackler

  • Gastroenterology Physician
  • Fort Collins, CO
National Provider Identifier
1174984801
Registry record updated Jul 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
DR.0062065 Issued in CO
Practice address
3702 S Timberline Rd Ste a
Fort Collins, CO 80525-3625
Phone
(970) 207-9773
NPI assigned
Mar 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Gastroenterology Physician 207RG0100X DR.0062065 CO Primary

Addresses

Primary practice location

3702 S Timberline Rd Ste a
Fort Collins, CO 80525-3625

Mailing address

3702 S Timberline Rd Ste a
Fort Collins, CO 80525-3625

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
I20220629001463 CO Practitioner - Internal MedicinePractitioner - Gastroenterology 3375835481 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Gastroenterology
Education
Rocky Vista University College of Osteopathic Med, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centers for GastroenterologyGroup PAC ID 9537059555, 38 clinicians

Practice addresses (Care Compare)

3702 S Timberline Rd
Suite a
Fort Collins, CO 80525-3625
Phone (970) 207-9773

Hospital & facility affiliations

  • Poudre Valley Hospital Hospital, Fort Collins, CO, CCN 060010
  • Uchealth Greeley Hospital Hospital, Greeley, CO, CCN 060131
  • Medical Center of the Rockies Hospital, Loveland, CO, CCN 060119

Merit-based Incentive Payment System (MIPS)

Final score
71.44 of 100Reported as individual
Quality
86.36
Promoting interoperability
100
Improvement activities
40
Cost
18.42

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy127
Upper gastrointestinal (GI) endoscopy for acid reflux159

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Centers for Gastroenterology Gastroenterology CurrentSince Aug 1, 2022 Accepting new patients

Locations

3702 S Timberline Rd
Ste A
Fort Collins, CO 80525
Phone (970) 207-9773

3702 S Timberline Rd
Fort Collins, CO 80525
Phone (970) 207-9773

Organizations & group practices 1

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 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1457395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659052800000",
    "number": "1174984801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 S TIMBERLINE RD STE A",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 S TIMBERLINE RD STE A",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253625",
            "telephone_number": "970-207-9773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACKLER",
        "first_name": "JACLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-08",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CO",
            "license": "DR.0062065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.