NPIMap

Individual provider Active NPI

Jacob Matthew Weasel, MD

  • Surgery Physician
  • Des Moines, IA
National Provider Identifier
1346686458
Registry record updated May 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
R-9654 Issued in IA
Practice address
1415 Woodland Ave
Suite 140
Des Moines, IA 50309-3203
Phone
(515) 241-4078
Fax
(515) 241-4080
NPI assigned
May 15, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X R-9654 IA Primary

Addresses

Primary practice location

1415 Woodland Ave
Suite 140
Des Moines, IA 50309-3203

Mailing address

1415 Woodland Ave
Suite 140
Des Moines, IA 50309-3203
Phone (515) 241-4078

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180927002373 SD Practitioner - General Surgery 0840439733 Reassigns benefits to 2 organizations
I20251015002969 TX Practitioner - General Surgery 0840439733 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Nebraska College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians
Monument Health Rapid City Hospital IncGroup PAC ID 6002729506, 560 clinicians

Practice addresses (Care Compare)

12505 Lebanon Rd
Suite 1442
Frisco, TX 75035-8298
Phone (972) 963-3550

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-8109

821 N Coleman St
Suite 100
Prosper, TX 75078-2339
Phone (469) 800-5200

Hospital & facility affiliations

  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077
  • Baylor Scott and White Medical Center Frisco at PG Hospital, Frisco, TX, CCN 670346
  • Baylor Scott & White Medical Center - Centennial Hospital, Frisco, TX, CCN 450885

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-9654IAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera St. Luke'S Current Accepting new patients
Avera St. Lukes CurrentSince Jun 1, 2021 Accepting new patients
Avera St. Luke'S CurrentSince Jun 1, 2021 Accepting new patients
Avera St Marys CurrentSince Jun 21, 2019 Accepting new patients
Avera St Marys Current Accepting new patients
Healthtexas Provider Network Surgery Current Accepting new patients
Monument Health Rapid City Hospital, Inc Current Accepting new patients
Healthtexas Provider Network CurrentSince Nov 3, 2025 Accepting new patients
Healthtexas Provider Network CurrentSince Nov 3, 2025 Accepting new patients
Avera St Marys CurrentSince Jun 21, 2019 Accepting new patients
Healthtexas Provider Network Past Accepting new patients
Monument Health Rapid City Hospital, Inc. Past Accepting new patients

Locations

2805 5th St
Ste 100
Rapid City, SD 57701
Phone (605) 719-5700

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

Interoperability endpoints

  • Direct secure messaging: jacob.weasel@avera.sdhealthlink.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Monument Health Wall ClinicWall, SD, CCN 433802 Rural health clinic Corporate Director Jul 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 12

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368576000000",
    "number": "1346686458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 WOODLAND AVE",
            "address_2": "SUITE 140",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503093203",
            "telephone_number": "515-241-4078",
            "fax_number": "515-241-4080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 WOODLAND AVE",
            "address_2": "SUITE 140",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503093203",
            "telephone_number": "515-241-4078",
            "fax_number": "515-241-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEASEL",
        "first_name": "JACOB",
        "middle_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-15",
        "last_updated": "2013-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "R-9654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.