Individual provider Active NPI

Robert Jon Pensack, M.D.

  • Psychiatry Physician
  • Denver, CO
National Provider Identifier
1194031070
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
DR 24744 Issued in CO
Practice address
433 Ogden St
Denver, CO 80218-3813
Phone
(970) 846-4057
Fax
(303) 722-7857
NPI assigned
Aug 30, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X DR 24744 CO Primary

Addresses

Primary practice location

433 Ogden St
Denver, CO 80218-3813

Mailing address

433 Ogden St
Denver, CO 80218-3813
Phone (970) 846-4057

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR 24744COMDPsychiatry Physician

NPI Registry JSON

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

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1194031070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 OGDEN ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802183813",
            "telephone_number": "970-846-4057",
            "fax_number": "303-722-7857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 OGDEN ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802183813",
            "telephone_number": "970-846-4057",
            "fax_number": "303-722-7857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENSACK",
        "first_name": "ROBERT",
        "middle_name": "JON",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-30",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CO",
            "license": "DR 24744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.