Active NPI
Jeffrey Ketcham, M.D.
- Family Medicine Physician
- Colorado Springs, CO
National Provider Identifier
1548630700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD15412
- Practice address
- 12753 Mission Meadow Dr
Colorado Springs, CO 80921-7659 - Phone
- (831) 333-6159
- NPI assigned
- Sep 30, 2015
- Last updated
- Sep 30, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD15412 | SC | Primary |
Addresses
Primary practice location
12753 Mission Meadow Dr
Colorado Springs, CO 80921-7659
Mailing address
12753 Mission Meadow Dr
Colorado Springs, CO 80921-7659
Phone (831) 333-6159
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD15412 | SC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443571200000",
"number": "1548630700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12753 MISSION MEADOW DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809217659",
"telephone_number": "831-333-6159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12753 MISSION MEADOW DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809217659",
"telephone_number": "831-333-6159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETCHAM",
"first_name": "JEFFREY",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-30",
"last_updated": "2015-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "MD15412",
"primary": true
}
],
"identifiers": [],
"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 Sep 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.