Individual provider Active NPI

Jacqueline Lentz, NP

  • Adult Health Nurse Practitioner
  • Loveland, CO
National Provider Identifier
1225368368
Registry record updated Dec 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2008006015 Issued in OR
Practice address
1365 W 29TH St
Loveland, CO 80538-2561
Phone
(970) 667-6111
Fax
(970) 482-0198
NPI assigned
Jan 13, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2008006015 OR Primary
Gerontology Nurse Practitioner 363LG0600X 2008006016 OR
Nurse Practitioner 363L00000X 201050005NP OR

Addresses

Primary practice location

1365 W 29TH St
Loveland, CO 80538-2561

Mailing address

802 W Drake Rd
Fort Collins, CO 80526-5558
Phone (970) 494-6449

Other identifiers 1

IdentifierTypeStateIssuer
500619570MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, CO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100609000128 OR Practitioner - Nurse Practitioner 4688704224 Reassigns benefits to 1 organization
I20150406001900 CO Practitioner - Nurse Practitioner 4688704224

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Daiya Healthcare PLLCGroup PAC ID 6002158615, 80 clinicians

Practice addresses (Care Compare)

75 Shore Dr
Saint Helens, OR 97051-1125
Phone (206) 823-1004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
201050005NPORMDNurse Practitioner
2008006015ORMDAdult Health Nurse Practitioner
2008006016ORMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Daiya Healthcare PLLC CurrentSince May 14, 2021 Accepting new patients
Northern Colorado Hospitalists Professional LLC Past Accepting new patients

Locations

10435 SE Cora St
Portland, OR 97266
Phone (503) 760-1737

75 Shore Dr
Saint Helens, OR 97051
Phone (503) 397-2713

Organizations & group practices 2

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": "1263340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451260800000",
    "number": "1225368368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 W DRAKE RD",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805265558",
            "telephone_number": "970-494-6449",
            "fax_number": "970-482-0198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 W 29TH ST",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805382561",
            "telephone_number": "970-667-6111",
            "fax_number": "970-482-0198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LENTZ",
        "first_name": "JACQUELINE",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-13",
        "last_updated": "2015-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "2008006015",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OR",
            "license": "2008006016",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "201050005NP",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500619570",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.