Active NPI
Jake Russell Dishno
- Behavior Technician
- Colorado Springs, CO
National Provider Identifier
1457094070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 13725 Struthers Rd Ste 200
Colorado Springs, CO 80921-2488 - Phone
- (719) 301-5100
- NPI assigned
- Apr 20, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | CO | Primary |
Addresses
Primary practice location
13725 Struthers Rd Ste 200
Colorado Springs, CO 80921-2488
Mailing address
13725 Struthers Rd Ste 200
Colorado Springs, CO 80921-2488
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790211605 | Medicaid | CO |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650412800000",
"number": "1457094070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13725 STRUTHERS RD STE 200",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809212488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13725 STRUTHERS RD STE 200",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809212488",
"telephone_number": "719-301-5100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISHNO",
"first_name": "JAKE",
"middle_name": "RUSSELL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-20",
"last_updated": "2022-04-20",
"certification_date": "2022-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CO",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1790211605",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.