Individual provider Active NPI

Jeffrey Glenn Breithaupt, D.C.

  • Chiropractor
  • Wheat Ridge, CO
National Provider Identifier
1376803296
Registry record updated May 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6863 Issued in CO
Practice address
5091 Kipling St
Wheat Ridge, CO 80033-2325
Phone
(720) 974-9477
NPI assigned
May 24, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6863 CO Primary

Addresses

Primary practice location

5091 Kipling St
Wheat Ridge, CO 80033-2325

Mailing address

5091 Kipling St
Wheat Ridge, CO 80033-2325
Phone (720) 974-9477

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150715002015 MO Practitioner - Chiropractic 2860639218 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Cleveland Chiropractic College - Kansas City, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McCandless Chiropractic LLCGroup PAC ID 7517022502, 2 clinicians

Practice addresses (Care Compare)

425 W Pine St a
Bel Ray Wellness Center
Raymore, MO 64083-9692
Phone (816) 322-4774

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6863COMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
McCandless Chiropractic LLC Chiropractor CurrentSince Jun 8, 2015 Accepting new patients

Locations

425 W Pine St
Ste A
Raymore, MO 64083
Phone (816) 322-4774

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.

NPI Registry JSON

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

{
    "created_epoch": "1337817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337817600000",
    "number": "1376803296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5091 KIPLING ST",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800332325",
            "telephone_number": "720-974-9477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5091 KIPLING ST",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800332325",
            "telephone_number": "720-974-9477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREITHAUPT",
        "first_name": "JEFFREY",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-24",
        "last_updated": "2012-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "6863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheat Ridge, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.