Carley A Jacobs, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110002718 Issued in VA

Practice address

2300 Kati CT Ste a
Shelton, WA 98584-1926

Phone

(360) 426-0955

NPI assigned

Feb 6, 2008

Last updated

Feb 4, 2021By the provider in NPPES

Sex

Female

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 WA

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

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.

• Public Hospital District No 1 of Mason County

  dba Mason Health-Mason General Hospital

  • Critical Access Hospital
  • Shelton, WA
  • NPI 1760568752
  Medicare reassignment NPD (past)
• Public Hospital District No 1 of Mason County

  dba MGH Family Health, Ankle and Foot

  • Family Medicine Physician
  • Shelton, WA
  • NPI 1134573272
  NPD

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1093993560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1668",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985845001",
            "telephone_number": "360-426-0955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 KATI CT STE A",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985841926",
            "telephone_number": "360-426-0955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "761 S Main St",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "VA",
            "postal_code": "226641127",
            "country_code": "US",
            "telephone_number": "540-459-5112",
            "fax_number": "540-459-3565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "CARLEY",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-06",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110002718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rita Dyanne Ickert
• Ideas Unlimited Inc (The Healthcare Center)
• Heung In
• Joshua Ireland
• Sarah E Jacob, LPN, LMP
• Amy P Jacobsen, MA
• Mariann Sue Jacobson
• Makayla James, SUDPT
• John Janisko, PA-C
• Ma. Michelle Jayobo, BS

• Physician Assistant in Shelton, WA
• Providers in Shelton, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; 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.