NPIMap

Individual provider Active NPI

Jacob Clark Whitsitt, M.D.

  • Dermatology Physician
  • Longmont, CO
National Provider Identifier
1508250846
Registry record updated Sep 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
CDRH.0063067 Issued in CO
Practice address
1551 Professional LN Unit 280
Longmont, CO 80501-6965
Phone
(720) 494-3118
NPI assigned
Mar 25, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Dermatology Physician 207N00000X CDRH.0063067 CO Primary

Addresses

Primary practice location

1551 Professional LN Unit 280
Longmont, CO 80501-6965

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071

Other practice location 1

100 Cook Street
Suite 306
Denver, CO 80206
Phone (720) 516-6405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200716001593 CO Practitioner - Dermatology 0547555815 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Colorado School of Medicine, Denver, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

11083 Colorado Blvd
Firestone, CO 80504-5873
Phone (303) 833-8880

Hospital & facility affiliations

  • University of Colorado Hospital Authority Hospital, Aurora, CO, CCN 060024

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision54
Removal of skin lesions2197
Removal or shaving of skin growth56
Skin biopsy487

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
CDRH.0063067COMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Aug 17, 2020 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Aug 17, 2020 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

100 Cook St
Ste 310
Denver, CO 80206
Phone (720) 516-9160

100 Cook St
Ste 306
Denver, CO 80206
Phone (720) 516-9405

11083 Colorado Blvd
Firestone, CO 80504
Phone (303) 833-8880

1850 Mountain View Ave
Longmont, CO 80501
Phone (303) 776-1500

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 2

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.

Hospital & facility affiliations 27

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1427241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789084800000",
    "number": "1508250846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 PROFESSIONAL LN UNIT 280",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016965",
            "telephone_number": "720-494-3118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Cook Street",
            "address_2": "Suite 306",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "80206",
            "country_code": "US",
            "telephone_number": "720-516-6405",
            "fax_number": "720-516-9433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITSITT",
        "first_name": "JACOB",
        "middle_name": "CLARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-25",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": "CDRH.0063067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.