Individual provider Active NPI

Jeffrey G Stoll, PA

  • Physician Assistant
  • Boulder, CO
National Provider Identifier
1265405708
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0004872 Issued in CO
Practice address
2525 13TH St
Boulder, CO 80304-4104
Phone
(303) 449-6050
Fax
(720) 565-4128
NPI assigned
Feb 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DEN.00008865 CO
Physician Assistant 363A00000X PA.0004872 CO Primary

Addresses

Primary practice location

2525 13TH St
Boulder, CO 80304-4104

Mailing address

1735 S Public Rd Ste 203
Lafayette, CO 80026-7093
Phone (303) 665-3036

Other identifiers 1

IdentifierTypeStateIssuer
70609373MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jeffrey.stoll.p4@direct.clinicafamilyhealth.nextgenshare.com Direct

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170103001881 CO Practitioner - Physician Assistant 6204117377 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1735 S Public Rd
Lafayette, CO 80026-7093
Phone (303) 665-3036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
DEN.00008865COMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Clinica Campesina Family Health Services CurrentSince Jan 17, 2017 Accepting new patients
Clinica Campesina Family Health Services CurrentSince Jan 17, 2017 Accepting new patients
Clinica Campesina Family Health Services Past Accepting new patients

Locations

2525 13th St
Boulder, CO 80304
Phone (303) 449-6050

1735 S Public Rd
Lafayette, CO 80026
Phone 30366530361061

1345 Plaza Ct N
Ste 1A
Lafayette, CO 80026
Phone (303) 665-2962

1735 S Public Rd
Ste 203
Lafayette, CO 80026

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1265405708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 S PUBLIC RD STE 203",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800267093",
            "telephone_number": "303-665-3036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 13TH ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803044104",
            "telephone_number": "303-449-6050",
            "fax_number": "720-565-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOLL",
        "first_name": "JEFFREY",
        "middle_name": "G",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN.00008865",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "70609373",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeffrey.stoll.p4@direct.clinicafamilyhealth.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "NextGen EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "2525 13th St",
            "city": "Boulder",
            "state": "CO",
            "country_code": "US",
            "postal_code": "803044104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.