Jacob Nelson, DO
Individual provider Active NPI Pediatrics Physician · Saint Anthony, ID
NPI 1144675679 · NPPES record last updated Dec 19, 2025
Key facts
- NPI
- 1144675679
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- O-1220 (ID)
- Practice address
- PO Box 18
Saint Anthony, ID 83445-0018 - Phone
- (208) 356-4900
- Fax
- (208) 624-4112
- NPI assigned
- May 3, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- Touro Un Col of Osteopathic Medicine, Henderson, 2016
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1362 Maple Leaf LN
Rexburg, ID 83440-3306
PO Box
Suite 18
Saint Anthony, ID 83445
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250417000383 | TX | Practitioner - Pediatric Medicine | 0941725451 | Reassigns benefits to 1 organization |
| I20260309003131 | ID | Practitioner - Pediatric Medicine | 0941725451 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upper Valley Community Health Services Inc | Current |
Accepting new patients | |
| Chickasaw Nation Division of Health | Current |
Accepting new patients | |
| Chickasaw Nation Division of Health | Current |
Accepting new patients | |
| Upper Valley Community Health Services, Inc. | Current |
Accepting new patients | |
| Upper Valley Community Health Services Inc | Past | Accepting new patients | |
| Upper Valley Community Health Services Inc | Past | Accepting new patients | |
| Upper Valley Community Health Services Inc | Past | Accepting new patients | |
| Just 4 Kids Home Health | Past | Accepting new patients | |
| Just 4 Kids Health LLC | Pediatrics | Past | Accepting new patients |
| Chickasaw Nation Division of Health | Past | Accepting new patients | |
| Just 4 Kids Health LLC | Pediatrics | Past | Accepting new patients |
Locations
72 S 1st E
Ste 101
Rexburg, ID 83440
20 N 3rd E
Saint Anthony, ID 83445
Phone (208) 624-4100
335 E Main St
Ste 1
Saint Anthony, ID 83445
1921 Stonecipher Dr
Ada, OK 74820
Phone (580) 421-4570
2510 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-8181
1438 Hardcastle Blvd
Purcell, OK 73080
Phone (405) 527-4700
817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392
Interoperability endpoints
- jnelson64689@direct.chickasawnationhealth.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | O-1220 | ID | Yes |
Addresses
Primary practice location
PO Box 18
Saint Anthony, ID 83445-0018
Mailing address
PO Box 18
Saint Anthony, ID 83445-0018
Phone (208) 356-4900
Other practice location 1
335 E Main St Ste 1
Saint Anthony, ID 83445-1546
Phone (208) 356-4900
Other practice location 2
72 S 1st E Ste 101
Rexburg, ID 83440-1902
Phone (208) 356-4900
Other practice location 3
2454 N 25th E Ste 101
Idaho Falls, ID 83401
Phone (208) 356-4900
Other providers in Saint Anthony, ID
- Neil L Kunz
- Gabriel Aaron Lenz
- Katie M McFarland
- Whittney Kay Miller
- Jacob Wayne Moss
- Northfork Developmental Services Inc.
- Scott Nye
- Amy I Ohs
- Richard Palmer
- Tyler Palmer
All providers in Saint Anthony, ID · Pediatrics Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.