Active NPI
Mary A Jannik, PA
- Physician Assistant
- Louisville, CO
National Provider Identifier
1265653570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2355
- Practice address
- 950 Spruce St Ste 1H
Louisville, CO 80027-1977 - Phone
- (720) 598-1189
- Fax
- (720) 540-4250
- NPI assigned
- May 2, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2355 | CO | Primary |
Addresses
Primary practice location
950 Spruce St Ste 1H
Louisville, CO 80027-1977
Mailing address
950 Spruce St Ste 1H
Louisville, CO 80027-1977
Phone (720) 598-1189
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 017865 | Other | CO | KAISER COMMERCIAL NUMBER |
| 41920571 | Medicaid | CO |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2355 | CO | MD | Physician Assistant |
Interoperability endpoints
- mary.jannik.1@2395.direct.athenahealth.com
Organizations & group practices 1
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.
-
- Sleep Medicine (Psychiatry & Neurology) Physician
- Louisville, CO
- NPI 1649502295
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785801600000",
"number": "1265653570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 SPRUCE ST STE 1H",
"city": "LOUISVILLE",
"state": "CO",
"postal_code": "800271977",
"telephone_number": "720-598-1189",
"fax_number": "720-540-4250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 SPRUCE ST STE 1H",
"city": "LOUISVILLE",
"state": "CO",
"postal_code": "800271977",
"telephone_number": "720-598-1189",
"fax_number": "720-540-4250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANNIK",
"first_name": "MARY",
"middle_name": "A",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2026-08-04",
"certification_date": "2026-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "2355",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER COMMERCIAL NUMBER",
"identifier": "017865",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41920571",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.