Trevor Dean Jacobson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M-12665 Issued in ID

Practice address

166 S 5TH St
Montpelier, ID 83254-4959

Phone

(208) 847-1110

Fax

(208) 847-0228

NPI assigned

May 28, 2009

Last updated

Dec 11, 2014By 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 ID

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

Specialty

Family Practice

Education

University of Utah School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bear Lake County Memorial HospitalGroup PAC ID 5395799860, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bear Lake Memorial Hospital Home Health Home health agency, Montpelier, ID, CCN 137069
• Bear Lake Memorial Hospital Hospital, Montpelier, ID, CCN 131316
• Intermountain Health Logan Regional Hospital Hospital, Logan, UT, CCN 460015
• Bear Lake Memorial Hospital Nursing home, CCN 13Z316

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tjacobson620120@direct.ochin.org

All facility ownership & control disclosures 1

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

Owned or controlled facilities with NPI records 1

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

• Bear Lake County Memorial Hospital

  • Skilled Nursing Facility
  • Montpelier, ID
  • NPI 1568552446

  Adp of the SNF, Corporate Director, Operational/Managerial Control

  CMS ownership

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.

• Bear Lake County Memorial Hospital

  dba Bear Lake Internal Medicine

  • Internal Medicine Physician
  • Montpelier, ID
  • NPI 1174741441
  Medicare reassignment Care Compare group NPD
• Bear Lake County Memorial Hospital

  dba BLMH Bear Lake Clinic

  • Multi-Specialty Clinic/Center
  • Garden City, UT
  • NPI 1538916333

  Family Medicine

  NPD
• Bear Lake County Memorial Hospital

  • Orthopaedic Surgery Physician
  • Montpelier, ID
  • NPI 1376871749
  NPD (past)

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

• Bear Lake County Memorial Hospital

  • Critical Access Hospital
  • Montpelier, ID
  • NPI 1336125533
  Care Compare affiliation
• Bear Lake County Memorial Hospital

  • Skilled Nursing Facility
  • Montpelier, ID
  • NPI 1659461531

  Nursing home

  Care Compare affiliation
• Bear Lake County Memorial Hospital

  • Home Health Agency
  • Montpelier, ID
  • NPI 1669521084
  Care Compare affiliation
• Ihc Health Services Inc

  dba Intermountain Health Logan Regional Hospital

  • General Acute Care Hospital
  • Logan, UT
  • NPI 1831108497
  Care Compare affiliation

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

{
    "created_epoch": "1243468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418256000000",
    "number": "1366677759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "832540069",
            "telephone_number": "208-847-1110",
            "fax_number": "208-847-0228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 S 5TH ST",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "832544959",
            "telephone_number": "208-847-1110",
            "fax_number": "208-847-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "TREVOR",
        "middle_name": "DEAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-28",
        "last_updated": "2014-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-12665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon J. Henscheid, PSY.D.
• Casey Humpherys
• Ory Brad Hutchison, PHARMD
• Gregory William Hyde, DPT
• Flint Dean Jacobson, NP
• Marilee Johnson, MRC, LPC
• Joseph F Decker Professional Corp
• Josh Bowman DC PLLC (Bowman Chiropractic)
• Angela K Kelly, LCSW
• Bobbi Jae Kelsey, LCSW

• Family Medicine Physician in Montpelier, ID
• Providers in Montpelier, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.