Jacob Burnell Penhollow, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

351530 Issued in NY

Practice address

116 Interstate Pkwy
Bradford, PA 16701-1036

Phone

(814) 362-8274

NPI assigned

Oct 9, 2024

Last updated

Oct 9, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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 NY, PA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Delphi Healthcare PLLCGroup PAC ID 9537229661, 68 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Olean General Hospital Hospital, Olean, NY, CCN 330103

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Delphi Healthcare PLLC

  • Emergency Medicine Physician
  • Rochester, NY
  • NPI 1003075029

  PA

  Medicare reassignment Care Compare group NPD

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

• Olean General Hospital

  • General Acute Care Hospital
  • Olean, NY
  • NPI 1225083074
  Care Compare affiliation
• Olean General Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Olean, NY
  • NPI 1699715904
  Care Compare affiliation

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

{
    "created_epoch": "1728432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1285453936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 CHILI AVE STE 200",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146243035",
            "telephone_number": "585-426-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 INTERSTATE PKWY",
            "city": "BRADFORD",
            "state": "PA",
            "postal_code": "167011036",
            "telephone_number": "814-362-8274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 Main St",
            "address_purpose": "LOCATION",
            "city": "Olean",
            "state": "NY",
            "postal_code": "147601598",
            "country_code": "US",
            "telephone_number": "716-373-2600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENHOLLOW",
        "first_name": "JACOB",
        "middle_name": "BURNELL",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-09",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "351530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lexandria Pascarella, PA
• Matthew Scott Pascuzzi, PTA
• Abbey Paulsen, CRNP
• David Peleg, M.D.
• Dana J Pence, PT
• Penn North Centers for Advanced Wound Care Inc
• Penndoc Foot & Ankle Center, LLC
• Pennsylvania CVS Pharmacy LLC (CVS Pharmacy # 04270)
• Eric Peters, LCSW
• Lori Ann Peterson

• Family Nurse Practitioner in Bradford, PA
• Providers in Bradford, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.