Individual provider Active NPI

Jacob Tyler Corbett, PA-C

  • Physician Assistant
  • Toledo, OH
National Provider Identifier
1063916070
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.005439RX Issued in OH
Practice address
2940 N McCord Rd
Toledo, OH 43615-1753
Phone
(419) 842-3000
Fax
(419) 291-9883
NPI assigned
Mar 23, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.005439RX OH Primary

Addresses

Primary practice location

2940 N McCord Rd
Toledo, OH 43615-1753

Mailing address

1 Seagate Ste 800
Toledo, OH 43604-1558

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jcorbett126313@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20180612003047 OH Practitioner - Physician Assistant 6406101666 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4000

2901 N Reynolds Rd
Toledo, OH 43606
Phone (419) 578-7700

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.005439RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians Physician Assistant CurrentSince Oct 1, 2023 Accepting new patients
The Toledo Hospital CurrentSince Jun 24, 2018 Accepting new patients
The Toledo Hospital CurrentSince Jun 24, 2018 Accepting new patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
Promedica Central Physicians CurrentSince Oct 1, 2023 Accepting new patients

Locations

2801 Bay Park Dr
Oregon, OH 43616
Phone (419) 690-7652

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

1 Seagate
Ste 800
Toledo, OH 43604

2940 N McCord Rd
Toledo, OH 43615
Phone (419) 842-3000

1 Seagate
#800
Toledo, OH 43604
Phone (567) 585-1964

2109 Hughes Dr
Ste 720
Toledo, OH 43606
Phone (419) 291-2077

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

Interoperability endpoints

  • Direct secure messaging: jacob.corbett.p1@direct.whc.nextgenshare.com
  • Direct secure messaging: jcorbett126313@direct.promedica.org

Organizations & group practices 8

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": "1521763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1063916070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SEAGATE STE 800",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041558",
            "fax_number": "419-824-7359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 N MCCORD RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436151753",
            "telephone_number": "419-842-3000",
            "fax_number": "419-291-9883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORBETT",
        "first_name": "JACOB",
        "middle_name": "TYLER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-23",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.005439RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcorbett126313@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.