NPIMap

Individual provider Active NPI

Jill R. Vanwyk, M.D.

  • Family Medicine Physician
  • Boulder, CO
National Provider Identifier
1235287541
Registry record updated Nov 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR0052110 Issued in CO
Practice address
5495 Arapahoe Ave
Boulder, CO 80303-1260
Phone
(720) 848-9200
NPI assigned
Jan 5, 2007
Last updated
Nov 16, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DR0052110 CO Primary

Addresses

Primary practice location

5495 Arapahoe Ave
Boulder, CO 80303-1260

Mailing address

350 Broadway St
Boulder, CO 80305-3343
Phone (720) 848-9200

Other identifiers 1

IdentifierTypeStateIssuer
8437485MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140326001480 CO Practitioner - Family Practice 8729003249 Reassigns benefits to 2 organizations
I20250108000361 MN Practitioner - Family Practice 8729003249

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lin Health Medical Group PAGroup PAC ID 1557726932, 7 clinicians
Westminster, IncGroup PAC ID 0648447342, 4 clinicians

Practice addresses (Care Compare)

3513 Brighton Blvd
Suite 457
Denver, CO 80216-3810
Phone (720) 740-2520

8601 Turnpike Dr
Unit 200
Westminster, CO 80031-7044
Phone (303) 428-7449

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR0052110COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Westminster, Inc Family Medicine CurrentSince Jan 1, 2025 Accepting new patients
University of Colorado Hospital Authority Past Accepting new patients
University Physicians Incorporated Family Medicine Past Accepting new patients
University Physicians, Incorporated Past Accepting new patients

Locations

1350 Tulip St
Longmont, CO 80501
Phone (303) 776-6872

8601 Turnpike Dr
Unit 200
Westminster, CO 80031
Phone (303) 428-7449

Interoperability endpoints

  • Direct secure messaging: jill.vanwyk.1@25015.direct.athenahealth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 68

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

View all 68

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510790400000",
    "number": "1235287541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803053343",
            "telephone_number": "720-848-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5495 ARAPAHOE AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031260",
            "telephone_number": "720-848-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANWYK",
        "first_name": "JILL",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2017-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR0052110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8437485",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.