Jacob Nelson, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

O-1220 Issued in ID

Practice address

PO Box 18
Saint Anthony, ID 83445-0018

Phone

(208) 356-4900

Fax

(208) 624-4112

NPI assigned

May 3, 2016

Last updated

Dec 19, 2025By the provider in NPPES

Sex

Male

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 TX, ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Pediatric Medicine

Education

Touro Un Col of Osteopathic Medicine, Henderson, 2016

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jnelson64689@direct.chickasawnationhealth.net

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.

• Chickasaw Nation Division of Health

  dba Chickasaw Nation Medical Center

  • General Acute Care Hospital
  • Ada, OK
  • NPI 1255364923

  TX

  Medicare reassignment NPD
• Upper Valley Community Health Services Inc

  dba Grand Peaks Medical

  • Federally Qualified Health Center (FQHC)
  • Saint Anthony, ID
  • NPI 1972792489
  Medicare reassignment NPD (past)
• Upper Valley Community Health Services Inc

  dba Grand Peaks Behavioral Health

  • Federally Qualified Health Center (FQHC)
  • Saint Anthony, ID
  • NPI 1396507190
  NPD
• Upper Valley Community Health Services, Inc.

  dba Grand Peaks Medical and Behavioral Health

  • Federally Qualified Health Center (FQHC)
  • Dubois, ID
  • NPI 1649142712
  NPD
• Chickasaw Nation Division of Health Chickasaw Nation Medical Center

  dba Minticha Apila

  • Home Health Agency
  • Ada, OK
  • NPI 1811739071
  NPD
• Just 4 Kids Health LLC

  dba Just 4 Kids Urgent Care

  • Urgent Care Clinic/Center
  • Idaho Falls, ID
  • NPI 1043722259

  Pediatrics

  NPD (past)
• Just 4 Kids Health LLC

  dba Just 4 Kids Primary Care

  • Pediatrics Physician
  • Rexburg, ID
  • NPI 1083338651
  NPD (past)
• Just 4 Kids Home Health

  • Home Health Agency
  • Idaho Falls, ID
  • NPI 1396372041
  NPD (past)
• Upper Valley Community Health Services Inc

  dba Grand Peaks Medical

  • Federally Qualified Health Center (FQHC)
  • Rexburg, ID
  • NPI 1124403258
  NPD (past)
• Upper Valley Community Health Services Inc

  dba Grand Peaks Medical

  • Federally Qualified Health Center (FQHC)
  • Idaho Falls, ID
  • NPI 1932961810
  NPD (past)
• Chickasaw Nation Division of Health

  dba Chickasaw Nation Tishomingo Clinic

  • Primary Care Clinic/Center
  • Tishomingo, OK
  • NPI 1649330242
  NPD (past)

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

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766102400000",
    "number": "1144675679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18",
            "city": "SAINT ANTHONY",
            "state": "ID",
            "postal_code": "834450018",
            "telephone_number": "208-356-4900",
            "fax_number": "208-624-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 18",
            "city": "SAINT ANTHONY",
            "state": "ID",
            "postal_code": "834450018",
            "telephone_number": "208-356-4900",
            "fax_number": "208-624-4112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "335 E Main St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Saint Anthony",
            "state": "ID",
            "postal_code": "834451546",
            "country_code": "US",
            "telephone_number": "208-356-4900",
            "fax_number": "208-624-4112",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2454 N 25th E Ste 101",
            "address_purpose": "LOCATION",
            "city": "Idaho Falls",
            "state": "ID",
            "postal_code": "83401",
            "country_code": "US",
            "telephone_number": "208-356-4900",
            "fax_number": "208-612-6118",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "72 S 1st E Ste 101",
            "address_purpose": "LOCATION",
            "city": "Rexburg",
            "state": "ID",
            "postal_code": "834401902",
            "country_code": "US",
            "telephone_number": "208-356-4900",
            "fax_number": "208-356-3724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JACOB",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-03",
        "last_updated": "2025-12-19",
        "certification_date": "2025-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "O-1220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neil L Kunz, D.M.D.
• Gabriel Aaron Lenz, DMD
• Katie M McFarland, LCSW
• Whittney Kay Miller, FNP-C
• Jacob Wayne Moss, M.D., J.D.
• Northfork Developmental Services Inc.
• Scott Nye
• Amy I Ohs, LCSW
• Richard Palmer, LPC
• Tyler Palmer, PTA

• Pediatrics Physician in Saint Anthony, ID
• Providers in Saint Anthony, ID by specialty
• Pediatrics Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.