Individual provider Active NPI

Jacob K Joseph, MD

  • Gastroenterology Physician
  • Fort Smith, AR
National Provider Identifier
1053330175
Registry record updated Aug 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
E-2646 Issued in AR
Practice address
6801 Rogers Ave
Fort Smith, AR 72903-4067
Phone
(479) 274-3200
Fax
(479) 274-3289
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X E-2646 AR Primary

Addresses

Primary practice location

6801 Rogers Ave
Fort Smith, AR 72903-4067

Mailing address

PO Box 3528
Fort Smith, AR 72913-3528
Phone (479) 274-2000

Other identifiers 2

IdentifierTypeStateIssuer
1053330175OtherRR MEDICARE
141426001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20091214000181 AR Practitioner - Gastroenterology 4183764749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6801 Rogers Ave
Fort Smith, AR 72903-4067
Phone (479) 274-4100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy199
Upper gastrointestinal (GI) endoscopy for acid reflux311

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-2646ARMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Fort Smith Communities CurrentSince Nov 1, 2017 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Nov 1, 2017 Accepting new patients
Mercy Hospital Fort Smith Past Accepting new patients

Locations

6801 Rogers Ave
Fort Smith, AR 72903
Phone (479) 314-6000

7001 Rogers Ave
Ste 200
Fort Smith, AR 72903
Phone (479) 314-4620

7001 Rogers Ave
Fort Smith, AR 72903
Phone (479) 478-3510

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440720000000",
    "number": "1053330175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3528",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729133528",
            "telephone_number": "479-274-2000",
            "fax_number": "479-274-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729034067",
            "telephone_number": "479-274-3200",
            "fax_number": "479-274-3289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOSEPH",
        "first_name": "JACOB",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2015-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AR",
            "license": "E-2646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "1053330175",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141426001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

Verify at the official NPI Registry.