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Individual provider Active NPI

Jody L Pendleton, LPC

  • Professional Counselor
  • Canon City, CO
National Provider Identifier
1255387197
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC.0002859 Issued in CO
Practice address
2480 High St
Canon City, CO 81212-8746
Phone
(719) 275-2591
NPI assigned
May 25, 2006
Last updated
Oct 29, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC.0002859 CO Primary

Addresses

Primary practice location

2480 High St
Canon City, CO 81212-8746

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (970) 624-4036

Other practice location 1

2450 S Peoria St Ste 245
Aurora, CO 80014-5475
Phone (303) 752-7732

Other practice location 2

400 W 16th St
Pueblo, CO 81003-2781
Phone (719) 584-4045

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240326000348 CO Practitioner - Mental Health Counselor 4082051198 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

2450 S Peoria
Suite 245 Uchmg Virtual Visit
Aurora, CO 80014-5475
Phone (303) 752-7732

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jan 28, 2024 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jan 28, 2024 Accepting new patients
Poudre Valley Medical Group, LLC PastSince Sep 20, 2020 Accepting new patients

Locations

2450 S Peoria St
Ste 245
Aurora, CO 80014
Phone (303) 752-7732

2450 S Peoria St
Ste 245UCHMG
Aurora, CO 80014
Phone (303) 752-7732

2450 S Peoria St
Ste 248
Aurora, CO 80014
Phone (303) 752-7747

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

Organizations & group practices 4

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1255387197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-624-4036",
            "fax_number": "970-490-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 HIGH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812128746",
            "telephone_number": "719-275-2591"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2450 S Peoria St Ste 245",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800145475",
            "country_code": "US",
            "telephone_number": "303-752-7732",
            "fax_number": "303-718-0965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 W 16th St",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810032781",
            "country_code": "US",
            "telephone_number": "719-584-4045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENDLETON",
        "first_name": "JODY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC.0002859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

Verify at the official NPI Registry.