Active NPI
Jack E Hall, PA
- Medical Physician Assistant
- Pueblo West, CO
National Provider Identifier
1619284239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 535
- Practice address
- 121 S Crescent Dr
Pueblo West, CO 81007-5434 - Phone
- (719) 595-7575
- Fax
- (719) 547-8368
- NPI assigned
- Sep 2, 2010
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 535 | CO | Primary |
Addresses
Primary practice location
121 S Crescent Dr
Pueblo West, CO 81007-5434
Mailing address
PO Box 560825
Denver, CO 80256-0825
Phone (719) 595-7580
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 63254808 | 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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 535 | CO | MD | Clinical Psychologist |
| 505 | NE | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| High Plains Medical Foundation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinic/Center
- Sidney, NE
- NPI 1710064316
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455753600000",
"number": "1619284239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 560825",
"city": "DENVER",
"state": "CO",
"postal_code": "802560825",
"telephone_number": "719-595-7580",
"fax_number": "719-545-0176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 S CRESCENT DR",
"city": "PUEBLO WEST",
"state": "CO",
"postal_code": "810075434",
"telephone_number": "719-595-7575",
"fax_number": "719-547-8368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL",
"first_name": "JACK",
"middle_name": "E",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-09-02",
"last_updated": "2016-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CO",
"license": "535",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "63254808",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo West, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.