Jacob Iw Addis
Individual provider Active NPI Community Health Worker · Athens, OH
NPI 1295435352 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1295435352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- Practice address
- 11 Graham Dr
Athens, OH 45701-1430 - Phone
- (800) 321-8293
- NPI assigned
- Mar 7, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integrated Services for Behavioral Health | Current |
Accepting new patients | |
| Integrated Services for Behavioral Health | Past |
Accepting new patients |
Locations
11 Graham Dr
Athens, OH 45701
Phone (740) 594-6807
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/isaoh/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Yes |
Addresses
Primary practice location
11 Graham Dr
Athens, OH 45701-1430
Mailing address
PO Box 132
Athens, OH 45701-0132
Other providers in Athens, OH
- Catherine Accorso
- Candice Adams
- Delaney Adams
- Emmanuel Adarkwa
- Barbara Adcock
- Justin Addy
- Sarah Elaine Adkins
- Affect Therapeutics, Inc.
- Ana Aguado
- Ibrahim Akmese
All providers in Athens, OH · Community Health Worker in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.