Thomas E Jacobsen, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2916 Issued in ND

Practice address

1000 Highway 12
Hettinger, ND 58639

Phone

(701) 567-4561

NPI assigned

Oct 3, 2006

Last updated

Jul 8, 2007By 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

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in SD

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Horizon Health Care Inc

  dba Aurora County Clinic

  • Federally Qualified Health Center (FQHC)
  • Plankinton, SD
  • NPI 1356459382
  Medicare reassignment NPD
• Horizon Health Care Inc

  dba Yankton Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Yankton, SD
  • NPI 1013445907
  NPD
• Horizon Health Care Inc

  dba Fort Thompson Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Fort Thompson, SD
  • NPI 1225411945
  NPD
• Community Action Partnership

  • Community Health Clinic/Center
  • Dickinson, ND
  • NPI 1174501712
  NPD (past)
• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053405662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 HIGHWAY 12",
            "city": "HETTINGER",
            "state": "ND",
            "postal_code": "586397533",
            "telephone_number": "701-567-6130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HIGHWAY 12",
            "city": "HETTINGER",
            "state": "ND",
            "postal_code": "58639",
            "telephone_number": "701-567-4561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "THOMAS",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "2916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12564",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7774910",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMP",
            "identifier": "123993",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIOUX VALLEY",
            "identifier": "20818",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3018140",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BC/BS",
            "identifier": "10775",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45034068812",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Helen Andrea Henley
• Hettinger Family Dental, P.C.
• Kent R Hoerauf, MD
• Rebecca Howe, APRN, FNP-C
• Courtney Hulm
• Kali Jacobson
• John P Joyce, MD
• Jessica Marie Kautz
• Ellen L Ketterling, MD
• Steven C Kilwein, DPM

• Family Medicine Physician in Hettinger, ND
• Providers in Hettinger, ND by specialty
• Family Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.