NPIMap

Individual provider Active NPI

Jacob Timothy Mach, PA

  • Physician Assistant
  • Alexandria, MN
National Provider Identifier
1124487038
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12506 Issued in MN
Practice address
1527 Broadway St
Alexandria, MN 56308-2537
Phone
(320) 762-0399
Fax
(320) 762-6847
NPI assigned
Feb 19, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 12506 MN Primary
Physician Assistant 363A00000X PA0004552 CO

Addresses

Primary practice location

1527 Broadway St
Alexandria, MN 56308-2537

Mailing address

PO Box 2010
Fargo, ND 58122-2484
Phone (701) 234-2000

Other practice location 1

15464 East Orchard Road
Centennial, CO 80016
Phone (303) 680-5437

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171212003267 MN Practitioner - Physician Assistant 8123386547 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1412 Main St
Hawley, MN 56549
Phone (218) 483-3564

1527 Broadway St
Alexandria, MN 56308-2537
Phone (320) 762-0399

Hospital & facility affiliations

  • Vivie Home Health Home health agency, Alexandria, MN, CCN 248096
  • Sanford Medical Center Fargo Hospital, Fargo, ND, CCN 350011
  • Alomere Health Hospital, Alexandria, MN, CCN 240030

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA0004552COMDPhysician Assistant
12506MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince Jul 30, 2022 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 30, 2022 Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients
Centennial Pediatrics, PC Past Accepting new patients

Locations

1527 Broadway St
Alexandria, MN 56308
Phone (320) 762-0399

4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200

115 E Soo St
Parkers Prairie, MN 56361
Phone (218) 338-4371

Organizations & group practices 5

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 7

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": "1455840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1124487038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2010",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581222484",
            "telephone_number": "701-234-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1527 BROADWAY ST",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563082537",
            "telephone_number": "320-762-0399",
            "fax_number": "320-762-6847"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15464 East Orchard Road",
            "address_purpose": "LOCATION",
            "city": "Centennial",
            "state": "CO",
            "postal_code": "80016",
            "country_code": "US",
            "telephone_number": "303-680-5437",
            "fax_number": "303-680-5439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACH",
        "first_name": "JACOB",
        "middle_name": "TIMOTHY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-19",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12506",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA0004552",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, MN

Sources for this page

Verify at the official NPI Registry.