Jacob Tall

Primary specialty

DentistTaxonomy code 122300000X

License

D-5144 Issued in ID

Practice address

2460 E 25TH St
Idaho Falls, ID 83404-7549

Phone

(208) 525-4780

NPI assigned

Jun 5, 2020

Sex

Male

Sole proprietor

Yes

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

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Enduradent PLLC

  • Dental Clinic/Center
  • Driggs, ID
  • NPI 1720656598
  NPD Authorized official
• Craig Darrington DDS PLLC

  • General Practice Dentistry
  • Idaho Falls, ID
  • NPI 1225768476
  NPD
• Mark a. Tall, P.a.

  • Dentist
  • Idaho Falls, ID
  • NPI 1275795395
  NPD (past)

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

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591315200000",
    "number": "1265056121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 E 25TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047549",
            "telephone_number": "208-525-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 E 25TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047549",
            "telephone_number": "208-525-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALL",
        "first_name": "JACOB",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-05",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-5144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deeann Briggs Tak, BSN-RN, CDCES
• Takoma Lindsay Counseling, LLC
• Brett Scott Talbot, M.D.
• Bradford L Talcott, M.D.
• Tall Family Physical Therapy PLLC
• Mark Asael Tall, DDS
• Michael Aldon Tall, D.D.S.
• Roger H Tall, MD
• Tambree Meadows Assisted Living
• Steven Adam Tank, MD

• Dentist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.