Active NPI
Jodi Gannon
- Specialist
- Paonia, CO
National Provider Identifier
1437570090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MT.0012638
- Practice address
- 41278 Lamborn Mesa Rd
Paonia, CO 81428-6432 - Phone
- (970) 527-7666
- NPI assigned
- Dec 30, 2013
- Last updated
- Dec 30, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | MT.0012638 | CO | Primary |
Addresses
Primary practice location
41278 Lamborn Mesa Rd
Paonia, CO 81428-6432
Mailing address
41278 Lamborn Mesa Rd
Paonia, CO 81428-6432
Phone (970) 527-7666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT.0012638 | CO | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388361600000",
"number": "1437570090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41278 LAMBORN MESA RD",
"city": "PAONIA",
"state": "CO",
"postal_code": "814286432",
"telephone_number": "970-527-7666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41278 LAMBORN MESA RD",
"city": "PAONIA",
"state": "CO",
"postal_code": "814286432",
"telephone_number": "970-527-7666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "JODI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-30",
"last_updated": "2013-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CO",
"license": "MT.0012638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paonia, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.