NPIMap

Individual provider Active NPI

Michael D Jacobson, PA-C

  • Medical Physician Assistant
  • Fort Collins, CO
National Provider Identifier
1013959188
Registry record updated Aug 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.0004358 Issued in CO
Practice address
2121 E Harmony Rd
Suite 300
Fort Collins, CO 80528-3400
Phone
(970) 224-9102
Fax
(970) 224-9112
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0110002152 VA
Medical Physician Assistant 363AM0700X PA.0004358 CO Primary

Addresses

Primary practice location

2121 E Harmony Rd
Suite 300
Fort Collins, CO 80528-3400

Mailing address

2121 E Harmony Rd
Suite 300
Fort Collins, CO 80528-3400
Phone (970) 224-9102

Other identifiers 1

IdentifierTypeStateIssuer
19730136MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051110000869 DC Practitioner - Physician Assistant 7810915584 Reassigns benefits to 1 organization
I20151026000114 CO Practitioner - Physician Assistant 7810915584 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

2121 E Harmony Rd
Fort Collins, CO 80528-3403

2500 Rocky Mountain Ave
Loveland, CO 80538-9004

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

529 Main St
Suite 102
Fort Morgan, CO 80701-2131
Phone (970) 867-7000

Hospital & facility affiliations

  • Poudre Valley Hospital Hospital, Fort Collins, CO, CCN 060010
  • Medical Center of the Rockies Hospital, Loveland, CO, CCN 060119

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0110002152VAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Apr 9, 2014 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Nov 23, 2015 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Nov 23, 2015 Accepting new patients
Privia Medical Group, LLC CurrentSince Apr 9, 2014 Accepting new patients
Pulmonary and Medical Associates of Northern Virginia LTD PastSince Nov 27, 2010 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

2121 E Harmony Rd
Unit 300
Fort Collins, CO 80528
Phone (970) 224-0429

529 Main St
Ste 102
Fort Morgan, CO 80701
Phone (970) 392-6980

6767 29th St
Greeley, CO 80634
Phone (970) 652-2000

6767 29th St
#2
Greeley, CO 80634

6767 29th St
Fl 2
Greeley, CO 80634
Phone (970) 652-2433

2500 Rocky Mountain Ave
Ste 300
Loveland, CO 80538
Phone (970) 619-6100

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

950 N Glebe Rd
#4000
Arlington, VA 22203

500 W Annandale Rd
Falls Church, VA 22046
Phone (703) 521-6662

8644 Sudley Rd
#220
Manassas, VA 20110

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1013959188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD",
            "address_2": "SUITE 300",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283400",
            "telephone_number": "970-224-9102",
            "fax_number": "970-224-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD",
            "address_2": "SUITE 300",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283400",
            "telephone_number": "970-224-9102",
            "fax_number": "970-224-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002152",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0004358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19730136",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.