NPIMap

Individual provider Active NPI

Frederick Jennings, PA-C

  • Surgical Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1679782791
Registry record updated Feb 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
1908 Issued in CO
Practice address
525 N Foote Ave
Ste 302
Colorado Springs, CO 80909-4501
Phone
(719) 365-5445
Fax
(719) 365-5530
NPI assigned
May 22, 2007
Last updated
Feb 16, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 1908 CO Primary

Addresses

Primary practice location

525 N Foote Ave
Ste 302
Colorado Springs, CO 80909-4501

Mailing address

2695 Rocky Mountain Ave
Suite 150
Loveland, CO 80538-8702
Phone (970) 624-4443

Other identifiers 1

IdentifierTypeStateIssuer
86376365MedicaidCO

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
I20040507000191 CO Practitioner - Physician Assistant 9830188788 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians
Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

1600 N Grand Ave
Pueblo, CO 81003-2757

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4921

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

4743 Arapahoe Ave
Suite 201
Boulder, CO 80303-1128
Phone (303) 442-2395

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1908COMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Oct 20, 2025 Accepting new patients
Boulder Community Health CurrentSince Oct 20, 2025 Accepting new patients
Boulder Community Health Current Accepting new patients
Memorial Health System Past Accepting new patients

Locations

1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450

4743 Arapahoe Ave
Ste 201
Boulder, CO 80303

Organizations & group practices 5

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 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424044800000",
    "number": "1679782791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE",
            "address_2": "SUITE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805388702",
            "telephone_number": "970-624-4443",
            "fax_number": "970-490-4175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N FOOTE AVE",
            "address_2": "STE 302",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809094501",
            "telephone_number": "719-365-5445",
            "fax_number": "719-365-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "FREDERICK",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2015-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "1908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "86376365",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.