NPIMap

Individual provider Active NPI

Jennifer Mommer, FNP

  • Family Nurse Practitioner
  • Fort Collins, CO
National Provider Identifier
1508374364
Registry record updated Dec 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0993566 Issued in CO
Practice address
2121 E Harmony Rd
Suite 100
Fort Collins, CO 80528-3401
Phone
(970) 221-1000
Fax
(970) 297-6886
NPI assigned
Jan 15, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0993566 CO Primary

Addresses

Primary practice location

2121 E Harmony Rd
Suite 100
Fort Collins, CO 80528-3401

Mailing address

2121 East Harmony Road
Ste 100
Fort Collins, CO 80528-3401
Phone (970) 221-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, WY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180709001156 CO Practitioner - Nurse Practitioner 4789930611 Reassigns benefits to 1 organization
I20240105004218 WY Practitioner - Nurse Practitioner 4789930611 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, shared by 2 NPIs, 2,425 clinicians

Practice addresses (Care Compare)

2121 E Harmony Rd
Unit 100 Uchmg Cardiology Fort Collins
Fort Collins, CO 80528-3401
Phone (970) 221-1000

255 N 30TH St
Laramie, WY 82072-5140
Phone (307) 742-9411

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0993566COMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jun 12, 2018 Accepting new patients
Poudre Valley Medical Group, LLC Current 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

1024 S Lemay Ave
#F1051
Fort Collins, CO 80524

1107 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 493-7442

2121 E Harmony Rd
Unit 100
Fort Collins, CO 80528
Phone (970) 663-3107

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

2500 Rocky Mountain Ave
Ste 100
Loveland, CO 80538
Phone (970) 624-1800

3116 Willett Dr
Laramie, WY 82072
Phone (307) 742-6319

255 N 30th St
Laramie, WY 82072
Phone (307) 742-2141

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1515974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575590400000",
    "number": "1508374364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 EAST HARMONY ROAD",
            "address_2": "STE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283401",
            "telephone_number": "970-221-1000",
            "fax_number": "970-297-6886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD",
            "address_2": "SUITE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283401",
            "telephone_number": "970-221-1000",
            "fax_number": "970-297-6886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOMMER",
        "first_name": "JENNIFER",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-15",
        "last_updated": "2019-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "0993566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.