Pamela Jean Jacobson, PSY.D., L.P.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP5828 Issued in MN

Practice address

517 N 17TH St
Montevideo, MN 56265-3067

Phone

(320) 269-6581

Fax

(855) 562-7905

NPI assigned

Oct 4, 2012

Sex

Female

Sole proprietor

No

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.

• Woodland Centers

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Willmar, MN
  • NPI 1295818862

  MN

  Medicare reassignment Care Compare group NPD

Specialty

Clinical Psychologist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Woodland Centers 39 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 23, 2015.

{
    "created_epoch": "1349308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450828800000",
    "number": "1255683066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 787",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562010787",
            "telephone_number": "320-235-4613",
            "fax_number": "855-625-7406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 N 17TH ST",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562653067",
            "telephone_number": "320-269-6581",
            "fax_number": "855-562-7905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "PAMELA",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "PSY.D., L.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-04",
        "last_updated": "2015-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP5828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Montevideo, MN
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; 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.