NPIMap

Individual provider Active NPI

Robert R Jacobsen, MD

  • Family Medicine Physician
  • Mount Vernon, WA
National Provider Identifier
1205890944
Registry record updated Aug 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00037278 Issued in WA
Practice address
1400 E Kincaid St
Attn: Credentialing
Mount Vernon, WA 98274-4127
Phone
(360) 428-2500
Fax
(360) 428-6485
NPI assigned
Apr 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00037278 WA Primary

Addresses

Primary practice location

1400 E Kincaid St
Attn: Credentialing
Mount Vernon, WA 98274-4127

Mailing address

1990 Hospital Dr
Suite 100
Sedro Woolley, WA 98284-9315
Phone (360) 856-4141

Other identifiers 1

IdentifierTypeStateIssuer
8242612MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041013000903 WA Practitioner - Family Practice 0042270167 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Public Hospital Dist No 1 SkagitGroup PAC ID 6800793522, 321 clinicians

Practice addresses (Care Compare)

1400 E Kincaid St
Mount Vernon, WA 98274-4127
Phone (360) 428-2500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00037278WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital Dist No 1 Skagit CurrentSince Sep 28, 2015 Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Sep 28, 2015 Accepting new patients
Public Hospital Dist No 1 Skagit Past Accepting new patients
Josephine Caring Community Past Accepting new patients
Dietrich & Smith Clinic Inc P S Past Accepting new patients

Locations

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

819 S 13th St
Mount Vernon, WA 98274
Phone (360) 336-9757

1990 Hospital Dr
Ste 100
Sedro Woolley, WA 98284
Phone (360) 856-4141

Interoperability endpoints

  • Direct secure messaging: rjacobsen15731@skagit.direct-ci.com

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440028800000",
    "number": "1205890944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 HOSPITAL DR",
            "address_2": "SUITE 100",
            "city": "SEDRO WOOLLEY",
            "state": "WA",
            "postal_code": "982849315",
            "telephone_number": "360-856-4141",
            "fax_number": "360-856-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E KINCAID ST",
            "address_2": "ATTN: CREDENTIALING",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127",
            "telephone_number": "360-428-2500",
            "fax_number": "360-428-6485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "ROBERT",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-12",
        "last_updated": "2015-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00037278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8242612",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.