Sophia Julia Jaeckel, DO

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

0010212 Issued in CO

Practice address

2698 Patterson Rd Ste 100
Grand Junction, CO 81506-8211

Phone

(970) 298-2874

NPI assigned

Apr 23, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1713830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1871348649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1880 DOVER ST",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802153187",
            "telephone_number": "720-243-2598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2698 PATTERSON RD STE 100",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815068211",
            "telephone_number": "970-298-2874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAECKEL",
        "first_name": "SOPHIA",
        "middle_name": "JULIA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-23",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "0010212",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "0010212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Jackson
• David Orlan Jacobson, DDS
• Debbie L Jacobson, RN
• Roger E Jacobson, M.D.
• Jacqueline'S Counseling Services LLC
• Fidencio Jaimes Jr.
• James F Goggans DMD PC
• James K Schroeder MD PC
• James M. Kennedy, D.D.S., P.C.
• James P Ford, DDS, PC

• Student in an Organized Health Care Education/Training Program in Grand Junction, CO
• Providers in Grand Junction, CO by specialty
• Student in an Organized Health Care Education/Training Program in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.