Individual provider Active NPI

Jessica Krueger

  • Family Medicine Physician
  • Denver, CO
National Provider Identifier
1962922005
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR.0063976 Issued in CO
Practice address
2130 Stout St
Denver, CO 80205-2827
Phone
(303) 293-2220
NPI assigned
Jun 20, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DR.0063976 CO Primary

Addresses

Primary practice location

2130 Stout St
Denver, CO 80205-2827

Mailing address

2111 Champa St
Denver, CO 80205-2529

Other practice location 1

13001 E 17th Pl
Aurora, CO 80045-2570
Phone (303) 724-5000

Other practice location 2

3600 Forbes Ave Ste 140
Pittsburgh, PA 15213-3410
Phone (412) 647-6340

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20170823003156 PA Order and Referring Only - Family PracticePractitioner - Family Practice 6901178128

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DR.0063976COMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1962922005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 CHAMPA ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802052529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 STOUT ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802052827",
            "telephone_number": "303-293-2220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13001 E 17th Pl",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800452570",
            "country_code": "US",
            "telephone_number": "303-724-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3600 Forbes Ave Ste 140",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152133410",
            "country_code": "US",
            "telephone_number": "412-647-6340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRUEGER",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-20",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0063976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.