Individual provider Active NPI

Cherilyn A Jacobson, P.A.

  • Physician Assistant
  • Evans, CO
National Provider Identifier
1962650069
Registry record updated Mar 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0005795 Issued in CO
Practice address
1400 37TH St
Evans, CO 80620-1906
Phone
(970) 348-1112
NPI assigned
Sep 3, 2008
Last updated
Mar 3, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0005795 CO Primary
Physician Assistant 363A00000X 3708 AZ

Addresses

Primary practice location

1400 37TH St
Evans, CO 80620-1906

Mailing address

1400 37TH St
Evans, CO 80620-1906
Phone (970) 348-1112

Other names 1

  • Miss Cherilyn A. Vail 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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210719001166 CO Practitioner - Physician Assistant 3577965268 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Arvada Pediatric Associates, PC CurrentSince Jan 28, 2024 Accepting new patients
Pediatric Group Specialists, LTD. PastSince Dec 13, 2022 Accepting new patients

Locations

3830 W 121st Pl
Broomfield, CO 80020
Phone (303) 410-8041

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772496000000",
    "number": "1962650069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 37TH ST",
            "city": "EVANS",
            "state": "CO",
            "postal_code": "806201906",
            "telephone_number": "970-348-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 37TH ST",
            "city": "EVANS",
            "state": "CO",
            "postal_code": "806201906",
            "telephone_number": "970-348-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "CHERILYN",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-03",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0005795",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "3708",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHERILYN",
            "last_name": "VAIL",
            "middle_name": "A.",
            "prefix": "MISS",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Evans, CO

Sources for this page

Verify at the official NPI Registry.