NPIMap

Individual provider Active NPI

Jason Pickerill

  • Occupational Therapist
  • Colorado Springs, CO
National Provider Identifier
1295025989
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT-2435 Issued in CO
Practice address
2790 N Academy Blvd Ste 250
Colorado Springs, CO 80917-5328
Phone
(719) 387-7775
Fax
(303) 223-0084
NPI assigned
Apr 14, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT-2435 CO Primary

Addresses

Primary practice location

2790 N Academy Blvd Ste 250
Colorado Springs, CO 80917-5328

Mailing address

16270 Forest Light Dr
Colorado Springs, CO 80908-2074
Phone (719) 644-1119

Other identifiers 3

IdentifierTypeStateIssuer
04A663OtherCOMEDICARE
16653254MedicaidCO
9000153835MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150914002522 CO Practitioner - Occupational Therapist in Private Practice 4688981343 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT-2435COMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rehab for All LLC Occupational Therapist CurrentSince May 1, 2015 Accepting new patients
Rehab for All LLC Past Accepting new patients
Rehab for All LLC Occupational Therapist Past Accepting new patients
Rehab for All LLC Past Accepting new patients
Rehab for All LLC Past Accepting new patients
Rehab for All LLC Past Accepting new patients
About Kids Ihss LLC PastSince Sep 1, 2019 Accepting new patients
Rehab for All LLC Past Accepting new patients
Therapeutic Interventions LLC Past Accepting new patients
Rehab for All Past Accepting new patients
About Kids Home Care, LLC Past Accepting new patients

Locations

2285 Fremont Dr
Canon City, CO 81212
Phone (719) 249-3620

2005 Aeroplaza Dr
Colorado Springs, CO 80916

401 Broadway Ave
Pueblo, CO 81004
Phone (719) 329-4208

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Act Home HealthDenton, TX, CCN 457965 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Corporate Director (100%)
Operational/Managerial Control (100%)		 Dec 31, 2023
Dec 31, 2023
Dec 31, 2023
About Kids Home Health CarePueblo, CO, CCN 067479 Home health agency 5% Or Greater Indirect Ownership Interest (100%)
Corporate Officer
Corporate Director
W-2 Managing Employee		 May 14, 2021
May 14, 2021
May 14, 2021
May 14, 2021

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 11

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": "1302739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1295025989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16270 FOREST LIGHT DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809082074",
            "telephone_number": "719-644-1119",
            "fax_number": "719-208-7730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 N ACADEMY BLVD STE 250",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175328",
            "telephone_number": "719-387-7775",
            "fax_number": "303-223-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKERILL",
        "first_name": "JASON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-14",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CO",
            "license": "OT-2435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "04A663",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16653254",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000153835",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.