Healthcare Provider Details
I. General information
NPI: 1639127574
Provider Name (Legal Business Name): JASON AARON MEHLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/04/2006
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1100 BALSAM AVE
BOULDER CO
80304-3404
US
IV. Provider business mailing address
36 GARDEN CTR
BROOMFIELD CO
80020-1730
US
V. Phone/Fax
- Phone: 303-532-3500
- Fax:
- Phone: 303-465-0401
- Fax: 303-438-1351
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2085R0204X |
| Taxonomy | Vascular & Interventional Radiology Physician |
| License Number | 48305 |
| License Number State | MN |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 450818YULQ |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MEDICARE BRI |
| # 2 | |
| Identifier | 1604152 |
| Identifier Type | OTHER |
| Identifier State | MN |
| Identifier Issuer | MEDICA |
| # 3 | |
| Identifier | 39730069 |
| Identifier Type | MEDICAID |
| Identifier State | CO |
| Identifier Issuer | |
| # 4 | |
| Identifier | 0720953 |
| Identifier Type | MEDICAID |
| Identifier State | IA |
| Identifier Issuer | |
| # 5 | |
| Identifier | 348484000 |
| Identifier Type | MEDICAID |
| Identifier State | WI |
| Identifier Issuer | |
| # 6 | |
| Identifier | HP62576 |
| Identifier Type | OTHER |
| Identifier State | MN |
| Identifier Issuer | HEALTHPARTNERS |
| # 7 | |
| Identifier | 127660300 |
| Identifier Type | MEDICAID |
| Identifier State | MN |
| Identifier Issuer | |
| # 8 | |
| Identifier | P00318045 |
| Identifier Type | OTHER |
| Identifier State | MN |
| Identifier Issuer | RAILROAD MEDICARE MN |
| # 9 | |
| Identifier | 113311 |
| Identifier Type | OTHER |
| Identifier State | MN |
| Identifier Issuer | UCARE |
| # 10 | |
| Identifier | 1046708 |
| Identifier Type | OTHER |
| Identifier State | MN |
| Identifier Issuer | PREFERRED ONE |
| # 11 | |
| Identifier | 2443320 |
| Identifier Type | OTHER |
| Identifier State | MN |
| Identifier Issuer | AMERICA'S PPO |
| # 12 | |
| Identifier | 507P3ME |
| Identifier Type | OTHER |
| Identifier State | MN |
| Identifier Issuer | BLUE CROSS BLUE SHIELD |
| # 13 | |
| Identifier | 99112127 |
| Identifier Type | OTHER |
| Identifier State | WI |
| Identifier Issuer | WI HEALTH INSURANCE RISK SHARING PLAN |
| # 14 | |
| Identifier | P00380132 |
| Identifier Type | OTHER |
| Identifier State | WI |
| Identifier Issuer | RAILROAD MEDICARE WI |
| # 15 | |
| Identifier | 1639127574 |
| Identifier Type | OTHER |
| Identifier State | MN |
| Identifier Issuer | MEDICA |
| # 16 | |
| Identifier | P01559590 |
| Identifier Type | OTHER |
| Identifier State | CO |
| Identifier Issuer | BRI MEDICARE RAILROAD |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
