Active NPI
Jacob Patrick Fay, BCBA
- Behavior Analyst
- Fayetteville, AR
National Provider Identifier
1124651559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-21-53551
- Practice address
- 3155 N College Ave Ste 108
Fayetteville, AR 72703-3500 - Phone
- (479) 957-9121
- NPI assigned
- Feb 13, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-21-53551 | AR | Primary |
| Behavior Technician | 106S00000X | RBT-19-85301 | AR |
Addresses
Primary practice location
3155 N College Ave Ste 108
Fayetteville, AR 72703-3500
Mailing address
3155 N College Ave Ste 108
Fayetteville, AR 72703-3500
Phone (479) 957-9121
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BACB495512 | Other | AR | BACB ID |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jfay@bluesprigpediatrics.com |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-19-85301 | AR | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633392000000",
"number": "1124651559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3155 N COLLEGE AVE STE 108",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727033500",
"telephone_number": "479-957-9121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3155 N COLLEGE AVE STE 108",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727033500",
"telephone_number": "479-957-9121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAY",
"first_name": "JACOB",
"middle_name": "PATRICK",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-02-13",
"last_updated": "2021-10-05",
"certification_date": "2021-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "AR",
"license": "1-21-53551",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "AR",
"license": "RBT-19-85301",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BACB ID",
"identifier": "BACB495512",
"state": "AR"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jfay@bluesprigpediatrics.com",
"affiliation": "N",
"address_1": "3155 N College Ave Ste 108",
"city": "Fayetteville",
"state": "AR",
"country_code": "US",
"postal_code": "727033500",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.