Jacob Daniel Collins, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

5901 W Olympic Blvd Ste 401
Los Angeles, CA 90036-4669

Phone

(310) 651-9017

Fax

(323) 954-1081

NPI assigned

Aug 28, 2018

Last updated

Nov 17, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Haven Health Group Los Angeles PC

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1740154392
  Medicare reassignment
• Peter J. Ruane, M.D. Inc.

  • Infectious Disease Physician
  • Los Angeles, CA
  • NPI 1881758688
  Medicare reassignment

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

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1033690961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 W OLYMPIC BLVD STE 401",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364669",
            "telephone_number": "310-651-9017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 W OLYMPIC BLVD STE 401",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364669",
            "telephone_number": "310-651-9017",
            "fax_number": "323-954-1081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "JACOB",
        "middle_name": "DANIEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-28",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connie Collins, LVN
• Deidre Collins, B.A.
• Donna Collins
• Gabriella Collins, LCSW
• Heather Irene Collins, NP
• Jaysanna Collins
• Jennifer L Collins
• Jennifer L. Collins, L.C.S.W.
• Jesse F Collins Jr., P.A.-C
• Jocella Collins

• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.