NPIMap

Individual provider Active NPI

Jeremy Jonathon Couch, FNP-BC

  • Family Nurse Practitioner
  • Pueblo, CO
National Provider Identifier
1679309868
Registry record updated Jul 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN.1619017 Issued in CO
Practice address
110 E Routt Ave
Pueblo, CO 81004-2117
Phone
(719) 584-8711
NPI assigned
Sep 12, 2024
Last updated
Jul 8, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2025

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 RN.1619017 CO Primary

Addresses

Primary practice location

110 E Routt Ave
Pueblo, CO 81004-2117

Mailing address

110 E Routt Ave
Pueblo, CO 81004-2117
Phone (719) 584-8711

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
I20241016003979 CO Practitioner - Nurse Practitioner 0345772232 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
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)

300 Colorado Ave
Pueblo, CO 81004-2006
Phone (719) 543-8711

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4000

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN.1619017COMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pueblo Community Health Center Inc CurrentSince Oct 15, 2024 Accepting new patients
Southern Colorado Emergency Medical Associates CurrentSince Nov 1, 2025 Accepting new patients
Pueblo Community Health Center Inc CurrentSince Oct 15, 2024 Accepting new patients
Pueblo Community Health Center Inc. Past Accepting new patients
Southern Colorado Emergency Medical Associates Family Past Accepting new patients

Locations

110 E Routt Ave
Pueblo, CO 81004
Phone (719) 543-8718

1301 E 7th St
Pueblo, CO 81001
Phone (719) 476-0220

300 Colorado Ave
Pueblo, CO 81004
Phone (719) 543-8718

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

899 E Industrial Blvd
Pueblo West, CO 81007
Phone (719) 288-2100

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1726099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1679309868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E ROUTT AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042117",
            "telephone_number": "719-584-8711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E ROUTT AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042117",
            "telephone_number": "719-584-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUCH",
        "first_name": "JEREMY",
        "middle_name": "JONATHON",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-12",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "RN.1619017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.