Jacob Shane Tebbs, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

10103875-1206 Issued in UT

Practice address

6051 N Eagle Rd
Boise, ID 83713-0997

Phone

(208) 519-4333

Fax

(208) 205-9134

NPI assigned

Sep 29, 2016

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 ID, WY2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

High Valley Dermatology and Dermatologic Surgery PLLCGroup PAC ID 1850433137, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• High Valley Dermatology & Dermatologic Surgery PLLC

  • MOHS-Micrographic Surgery Physician
  • Idaho Falls, ID
  • NPI 1891025334

  WY

  Medicare reassignment Care Compare group
• Teton Valley Health Care Inc

  • Rural Health Clinic/Center
  • Driggs, ID
  • NPI 1013264183
  Medicare reassignment
• Teton Valley Health Care Inc

  • Critical Access Hospital
  • Driggs, ID
  • NPI 1477809622
  Medicare reassignment
• D Peter Reedy MD PA

  • Neurological Surgery Physician
  • Boise, ID
  • NPI 1124226378
  NPD (past)
• High Valley Dermatology & Dermatologic Surgery, PC

  • MOHS-Micrographic Surgery Physician
  • Idaho Falls, ID
  • NPI 1255449898
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Care Compare affiliation

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

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596758400000",
    "number": "1154870251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 N STATE ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041305",
            "telephone_number": "801-373-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6051 N EAGLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130997",
            "telephone_number": "208-519-4333",
            "fax_number": "208-205-9134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "999 N Curtis Rd Ste 307",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837061333",
            "country_code": "US",
            "telephone_number": "208-519-4333",
            "fax_number": "208-205-9134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEBBS",
        "first_name": "JACOB",
        "middle_name": "SHANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-29",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "10103875-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Taylor, MA
• William L Taylor, M.D.
• Tdandc LLC
• Tdandc LLC
• Teaching Others to Embrace Mental Health LLC
• Leland Charles Tebout
• Matthew Kenji Techy, MD
• Laura Tedrick, M.D.
• Robert J Teears, M.D.
• David A Teed, LCSW

• Medical Physician Assistant in Boise, ID
• Providers in Boise, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; 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.