Active NPI
Gregory Earl Ketchum
- Social Worker
- Fort Collins, CO
National Provider Identifier
1245637958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 9620048
- Practice address
- 806 Rumford Court
Fort Collins, CO 80525 - Phone
- (970) 377-0992
- NPI assigned
- Nov 24, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 9620048 | CO | Primary |
Addresses
Primary practice location
806 Rumford Court
Fort Collins, CO 80525
Mailing address
806 Rumford Court
Fort Collins, CO 80525
Phone (970) 377-0992
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9620048 | CO | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416787200000",
"number": "1245637958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "806 RUMFORD COURT",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "80525",
"telephone_number": "970-377-0992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "806 RUMFORD COURT",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "80525",
"telephone_number": "970-377-0992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETCHUM",
"first_name": "GREGORY",
"middle_name": "EARL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-11-24",
"last_updated": "2014-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CO",
"license": "9620048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.