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Individual provider Active NPI

Lana Rae Jacobson, FAMILY NURSE PRACTIT

  • Family Nurse Practitioner
  • Grand Rapids, MN
National Provider Identifier
1275883266
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0257857-22 Issued in MN
Practice address
1401 NW 9TH Street
Grand Rapids, MN 55744
Phone
(218) 327-4961
NPI assigned
Sep 17, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 120342-4 MN
Family Nurse Practitioner 363LF0000X 0257857-22 MN Primary

Addresses

Primary practice location

1401 NW 9TH Street
Grand Rapids, MN 55744

Mailing address

1542 Golf Course Rd Ste 203
Grand Rapids, MN 55744-3557
Phone (218) 322-4900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20050110000624 MN Practitioner - Nurse Practitioner 8325096019 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Hospital & facility affiliations

  • Aveanna Home Health Home health agency, Grand Rapids, MN, CCN 248068
  • Essentia Health Deer River Hospital, Deer River, MN, CCN 241360
  • Grand Itasca Clinic and Hospital Hospital, Grand Rapids, MN, CCN 240064
  • Essentia Health Virginia Hospital, Virginia, MN, CCN 240084
  • Grand Village Nursing home, Grand Rapids, MN, CCN 245368

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
120342-4MNMDRegistered Nurse
0257857-22MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Deer River Healthcare Center, Inc CurrentSince Apr 4, 2016 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Apr 4, 2016 Accepting new patients
Deer River Healthcare Center, Inc. CurrentSince Apr 4, 2016 Accepting new patients
The Duluth Clinic LTD CurrentSince Apr 4, 2016 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
Deer River Healthcare Center, Inc. CurrentSince Nov 1, 2020 Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

115 10th Ave NE
Deer River, MN 56636
Phone (218) 246-2900

115 10th Ave NE
#A
Deer River, MN 56636
Phone (218) 246-8275

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

1542 Golf Course Rd
Ste 203
Grand Rapids, MN 55744
Phone (218) 999-7000

1542 Golf Course Rd
Ste 204
Grand Rapids, MN 55744
Phone (218) 322-4900

1232 Birch St N
Tower, MN 55790
Phone (218) 753-7788

Organizations & group practices 7

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 9

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": "1347840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1275883266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1542 GOLF COURSE RD STE 203",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443557",
            "telephone_number": "218-322-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 NW 9TH STREET",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "55744",
            "telephone_number": "218-327-4961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "LANA",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "FAMILY NURSE PRACTIT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-17",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "120342-4",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "0257857-22",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MN

Sources for this page

Verify at the official NPI Registry.