Individual provider Active NPI

Jody Lynn Gottesman, PSYD

  • Clinical Psychologist
  • Colorado Springs, CO
National Provider Identifier
1285842906
Registry record updated Mar 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0003999 Issued in CO
Practice address
5611 Constitution Ave
Colorado Springs, CO 80915-1218
Phone
(719) 492-5471
NPI assigned
May 18, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 0003999 CO Primary
Clinical Social Worker 1041C0700X LCSW 414 CO

Addresses

Primary practice location

5611 Constitution Ave
Colorado Springs, CO 80915-1218

Mailing address

5611 Constitution Ave
Colorado Springs, CO 80915-1218
Phone (719) 492-5471

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060322000538 CO Practitioner - Clinical Social Worker 9032127774 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

11820 Destination Dr
Broomfield, CO 80021-2518
Phone (720) 848-0000

Hospital & facility affiliations

  • Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW 414COMDClinical Social Worker
0003999COMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Sep 1, 2019 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Sep 1, 2019 Accepting new patients
Uch-MHS Past Accepting new patients

Locations

12605 E 16th Ave
Aurora, CO 80045
Phone (720) 848-0006

11820 Destination Dr
Broomfield, CO 80021
Phone (303) 460-6000

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

1400 E Boulder St
Colorado Springs, CO 80909
Phone (719) 365-5120

1400 E Boulder St
Ste 2508
Colorado Springs, CO 80909
Phone (719) 365-1292

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

Organizations & group practices 3

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.

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": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773100800000",
    "number": "1285842906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5611 CONSTITUTION AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809151218",
            "telephone_number": "719-492-5471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5611 CONSTITUTION AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809151218",
            "telephone_number": "719-492-5471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTESMAN",
        "first_name": "JODY",
        "middle_name": "LYNN",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "0003999",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "LCSW 414",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.