NPIMap

Organization Active NPI

JG LLC

Doing business as Family Walk In Clinic

  • Primary Care Clinic/Center
  • Greeley, CO
National Provider Identifier
1881101640
Registry record updated Mar 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
JG LLC
Doing business as
Family Walk In Clinic
Practice address
2928 W 10TH St
Greeley, CO 80634
Phone
(970) 584-2100
Fax
(970) 584-2101
NPI assigned
Jan 2, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2019

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

Authorized official

Name
Jeremy R Grover, PA-CNPI 1285734038
Title
Owner
Phone
(970) 584-2100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

2928 W 10TH St
Greeley, CO 80634

Mailing address

2928 W 10TH St
Greeley, CO 80634-5426
Phone (970) 584-2100

Other practice location 1

2918 W 10th St
Greeley, CO 80634-5457
Phone (970) 584-2100

Other identifiers 1

IdentifierTypeStateIssuer
1881101640MedicaidCO

Other names 1

  • Family Walk In Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180301000081 CO Part B Supplier - Clinic/Group Practice 3577824838 Receives reassigned benefits from 17 practitioners
Practice locations: Greeley, CO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2026118Family Walk in Clinic2928 W 10TH St, Greeley, CO 80634Certificate of waiverJun 22, 2027

National Provider Directory

National Provider Directory

Locations

2928 W 10th St
Greeley, CO 80634
Phone (970) 351-8181

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1514851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552521600000",
    "number": "1881101640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2928 W 10TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806345426",
            "telephone_number": "970-584-2100",
            "fax_number": "970-584-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2928 W 10TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "80634",
            "telephone_number": "970-584-2100",
            "fax_number": "970-584-2101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2918 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Greeley",
            "state": "CO",
            "postal_code": "806345457",
            "country_code": "US",
            "telephone_number": "970-584-2100",
            "fax_number": "970-584-2101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-02",
        "last_updated": "2019-03-14",
        "status": "A",
        "authorized_official_last_name": "GROVER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-584-2100",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881101640",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Walk In Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Walk In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greeley, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.