Individual provider Active NPI

Jade Ashley Wyatt, MD

  • Pediatric Endocrinology Physician
  • Colorado Springs, CO
National Provider Identifier
1629566922
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
License
DR.0073259 Issued in CO
Practice address
4125 Briargate Pkwy
Colorado Springs, CO 80920-7804
Phone
(719) 305-9400
NPI assigned
Apr 23, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology Physician 2080P0205X DR.0073259 CO Primary
Pediatrics Physician 208000000X 2021-01448 NC
Pediatrics Physician 208000000X 11414337-1205 UT

Addresses

Primary practice location

4125 Briargate Pkwy
Colorado Springs, CO 80920-7804

Mailing address

PO Box 110429
Aurora, CO 80042-0429

Other names 1

  • Jade Ashley Freeman Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240705002575 CO Practitioner - EndocrinologyPractitioner - Pediatric Medicine 9830522630 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2021-01448NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians Incorporated CurrentSince Jul 1, 2024 Accepting new patients
University Physicians, Incorporated CurrentSince Jul 1, 2024 Accepting new patients
University Physicians Incorporated Pediatrics Current Accepting new patients

Locations

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

4125 Briargate Pkwy
Colorado Springs, CO 80920
Phone (719) 305-8000

Dept 1061
Denver, CO 80256

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1524441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1629566922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110429",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800420429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4125 BRIARGATE PKWY",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207804",
            "telephone_number": "719-305-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "JADE",
        "middle_name": "ASHLEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-23",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "CO",
            "license": "DR.0073259",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2021-01448",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "11414337-1205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JADE",
            "last_name": "FREEMAN",
            "middle_name": "ASHLEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.