Active NPI
Kris N Jacobson, MD
- Gastroenterology Physician
- Medford, OR
National Provider Identifier
1083684633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- MD16535
- Practice address
- 2860 Creekside Circle
Medford, OR 97504 - Phone
- (541) 779-8367
- Fax
- (541) 779-7471
- NPI assigned
- Jan 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | MD16535 | OR | Primary |
Addresses
Primary practice location
2860 Creekside Circle
Medford, OR 97504
Mailing address
1917 E Main St
Medford, OR 97504
Phone (541) 770-2031
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| USA242450 | Medicaid | CA | |
| 008610 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192147200000",
"number": "1083684633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1917 E MAIN ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97504",
"telephone_number": "541-770-2031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2860 CREEKSIDE CIRCLE",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97504",
"telephone_number": "541-779-8367",
"fax_number": "541-779-7471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "KRIS",
"middle_name": "N",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-25",
"last_updated": "2007-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "OR",
"license": "MD16535",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "USA242450",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008610",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.