Amanda Jacobsen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.008421 Issued in IL

Practice address

320 E Central Ave
Decatur, IL 62521-4665

Phone

(217) 877-9117

NPI assigned

Jul 28, 2021

Sex

Female

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 IL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amanda.jacobsen.p31@direct.fhn-fqhc.nextgenshare.com

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.

• Community Health Improvement Center

  • Federally Qualified Health Center (FQHC)
  • Decatur, IL
  • NPI 1467784090
  Medicare reassignment
• Community Health Improvement Center

  • Federally Qualified Health Center (FQHC)
  • Decatur, IL
  • NPI 1164778031
  NPD
• Community Health Improvement Center

  • Federally Qualified Health Center (FQHC)
  • Decatur, IL
  • NPI 1831635770
  NPD

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

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627430400000",
    "number": "1174296941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 JACKSON WOODS CT NW",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524051920",
            "telephone_number": "319-521-3537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 E CENTRAL AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625214665",
            "telephone_number": "217-877-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "AMANDA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-28",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.008421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amia Jackson, RBT
• Debra Kay Jackson, M.D.
• Harmony Jackson
• Malinda M Jackson
• Royalty Jackson
• Jon Jacoby, MD
• Brian P Jacquot, P.A.-C
• Aftab Hassan Jafri, M.D.
• James C Allen DC LTD
• Sarah James

• Physician Assistant in Decatur, IL
• Providers in Decatur, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.