Active NPI
Jacob Hostetler, M.D.
- Family Medicine Physician
- Grove, OK
National Provider Identifier
1265829485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 31475
- Practice address
- 4602 US Highway 59
Grove, OK 74344-4229 - Phone
- (918) 877-1211
- Fax
- (918) 877-1216
- NPI assigned
- Apr 26, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 31475 | OK | Primary |
Addresses
Primary practice location
4602 US Highway 59
Grove, OK 74344-4229
Mailing address
PO Box 450130
Grove, OK 74345-0130
Phone (918) 877-1211
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200659910B | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180628002168 | OK | Practitioner - Family Practice | 5395048599 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Kansas School of Med (KC/Wich/Sal), 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4602 US Hwy 59
Grove, OK 74344-4229
Phone (918) 877-1211
Hospital & facility affiliations
- Via Life Home Health Care
- Carter Healthcare of Oklahoma, LLC
- Vialife Hospice LLC
- Integris Grove Hospital
- Saint Francis Hospital Vinita, Inc
- Integris Miami Hospital
- Mercy Hospital Joplin
- Freeman Health System - Freeman West
Merit-based Incentive Payment System (MIPS)
- Final score
- 19.04 of 100
- Quality
- 0
- Improvement activities
- 0
- Cost
- 63.46
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 15 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31475 | OK | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alpha M.D., PLC | Family Medicine | Current | Accepting new patients |
Locations
4602 US Highway 59 N
Grove, OK 74344
Phone (918) 787-2242
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/DFGHCD/Endpoint/DFGHCD
Organizations & group practices 1
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.
Hospital & facility affiliations 13
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Vinita, OK
- NPI 1659384956
-
- Medicare Defined Swing Bed Hospital Unit
- Vinita, OK
- NPI 1467902460
Hospital
-
- Home Health Agency
- Pryor, OK
- NPI 1134116809
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Webb City, MO
- NPI 1114394228
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668297600000",
"number": "1265829485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 450130",
"city": "GROVE",
"state": "OK",
"postal_code": "743450130",
"telephone_number": "918-877-1211",
"fax_number": "918-877-1216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4602 US HIGHWAY 59",
"city": "GROVE",
"state": "OK",
"postal_code": "743444229",
"telephone_number": "918-877-1211",
"fax_number": "918-877-1216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOSTETLER",
"first_name": "JACOB",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-26",
"last_updated": "2022-11-13",
"certification_date": "2022-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "31475",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200659910B",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grove, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2022; 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.