Individual provider Active NPI

Jack L Sharon, MD

  • Emergency Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1225087265
Registry record updated Dec 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
33591 Issued in CO
Practice address
2222 N Nevada Ave
Colorado Springs, CO 80907-6819
Phone
(719) 766-5333
Fax
(719) 766-5651
NPI assigned
May 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 33591 CO Primary

Addresses

Primary practice location

2222 N Nevada Ave
Colorado Springs, CO 80907-6819

Mailing address

2222 N Nevada Ave
Attn: Front Range Emergency Specialists
Colorado Springs, CO 80907-6819
Phone (719) 475-0299

Other identifiers 2

IdentifierTypeStateIssuer
930106279OtherCORR MEDICARE
01335918MedicaidCO

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100420000035 CO Practitioner - Emergency Medicine 0345377693 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33591COMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prowers County Hospital District CurrentSince Apr 1, 2020 Accepting new patients

Locations

401 Kendall Dr
Lamar, CO 81052
Phone (719) 336-4343

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.

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354492800000",
    "number": "1225087265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 N NEVADA AVE",
            "address_2": "ATTN: FRONT RANGE EMERGENCY SPECIALISTS",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076819",
            "telephone_number": "719-475-0299",
            "fax_number": "719-475-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 N NEVADA AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076819",
            "telephone_number": "719-766-5333",
            "fax_number": "719-766-5651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARON",
        "first_name": "JACK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-08",
        "last_updated": "2012-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "33591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "930106279",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01335918",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.