Jackie Lynne McCollum, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

28393 Issued in CO

Practice address

12101 E 2ND Ave Ste 105
Aurora, CO 80011-8328

Phone

(720) 535-6204

Fax

(720) 949-0540

NPI assigned

Jul 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Dr Jackie L McCollum, MD. P.C.

  • Point of Service
  • Aurora, CO
  • NPI 1174706808
  NPD Authorized official

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654819200000",
    "number": "1316966674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12101 E 2ND AVE STE 105",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800118328",
            "telephone_number": "720-535-6204",
            "fax_number": "720-949-0540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12101 E 2ND AVE STE 105",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800118328",
            "telephone_number": "720-535-6204",
            "fax_number": "720-949-0540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOLLUM",
        "first_name": "JACKIE",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "28393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01283936",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron Wayne McCloud, PA-C
• Erin Elizabeth McClure, MA, LPC
• Heather McClure
• Jared Theodore McClure
• Bruce McCollister, MD
• Joanna Marie McComb
• Tiffany Dawn McCombs, DNP, CPNP-AC
• Nicholle Danne McConico
• Brice McConnell, M.D., PH.D.
• Brook Kim McConnell, MD

• Family Medicine Physician in Aurora, CO
• Providers in Aurora, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; 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.

Verify at the official NPI Registry.