Individual provider Active NPI

Jacob Brad Rabe, M.D.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Peoria, IL
National Provider Identifier
1295029148
Registry record updated Oct 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
MD60455396 Issued in WA
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(309) 655-6710
NPI assigned
Jun 7, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207PE0004X MD60455396 WA Primary
Emergency Medicine Physician 207P00000X 125.059410 IL

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

504 W Melbourne Ave
Peoria, IL 61604-2844
Phone (801) 458-8549

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20140916002691 WA Practitioner - Emergency Medicine 5092934430 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Washington School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spokane Emergency Care Physicians PLLCGroup PAC ID 0143554600, 68 clinicians

Practice addresses (Care Compare)

800 W 5TH Ave
Spokane, WA 99204-2803
Phone (509) 473-7101

Hospital & facility affiliations

  • Multicare Valley Hospital Hospital, Spokane Valley, WA, CCN 500119
  • Deaconess Medical Center Hospital, Spokane, WA, CCN 500044

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125.059410ILMDEmergency Medicine Physician
MD60455396WAMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Multi-Specialty CurrentSince Apr 15, 2019 Accepting new patients
Multicare Health System Multi-Specialty Current Accepting new patients
Spokane Emergency Care Physicians PLLC Multi-Specialty CurrentSince Dec 30, 2019 Accepting new patients
Multicare Health System CurrentSince Apr 15, 2019 Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

800 W 5th Ave
Spokane, WA 99204
Phone (509) 458-5800

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Organizations & group practices 4

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 2

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": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571961600000",
    "number": "1295029148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 W MELBOURNE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616042844",
            "telephone_number": "801-458-8549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RABE",
        "first_name": "JACOB",
        "middle_name": "BRAD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-07",
        "last_updated": "2019-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "WA",
            "license": "MD60455396",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125.059410",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.