Individual provider Active NPI

Jacob Michael Shaw, PA-C

  • Physician Assistant
  • Baton Rouge, LA
National Provider Identifier
1376198614
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
320113 Issued in LA
Practice address
16777 Medical Center Dr
Baton Rouge, LA 70816-3254
Phone
(225) 761-5200
Fax
(225) 754-5052
NPI assigned
Aug 5, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 320113 LA Primary

Addresses

Primary practice location

16777 Medical Center Dr
Baton Rouge, LA 70816-3254

Mailing address

16777 Medical Center Dr
Baton Rouge, LA 70816-3254
Phone (225) 761-5200

Other practice location 1

201 4th St Ste 1D
Alexandria, LA 71301-8421
Phone (318) 443-4514

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191209002604 LA Practitioner - Physician Assistant 6103259981 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ochsner Clinic LLCGroup PAC ID 8224933619, 2,845 clinicians

Practice addresses (Care Compare)

1514 Jefferson Hwy
New Orleans, LA 70121-2429
Phone (504) 842-3000

1516 Jefferson Hwy
New Orleans, LA 70121-2429
Phone (504) 842-3470

16777 Medical Ctr Dr
Baton Rouge, LA 70816-3254
Phone (225) 754-3278

71380 Hwy 21
Covington, LA 70433-7245
Phone (985) 661-3534

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC CurrentSince Oct 21, 2019 Accepting new patients
Ochsner Clinic LLC CurrentSince Oct 21, 2019 Accepting new patients
Ochsner Clinic LLC Past Accepting new patients
Rapides Regional Physician Group Primary Care, LLC PastSince Jun 12, 2022 Accepting new patients

Locations

16777 Medical Center Dr
Baton Rouge, LA 70816
Phone (225) 754-3278

17000 Medical Center Dr
Baton Rouge, LA 70816
Phone (225) 752-2470

180 W Esplanade Ave
Kenner, LA 70065
Phone (504) 464-8284

200 W Esplanade Ave
Kenner, LA 70065
Phone (504) 464-2940

1514 Jefferson Hwy
New Orleans, LA 70121

Interoperability endpoints

  • Direct secure messaging: jshaw868537@direct.ochsner.org
  • Direct secure messaging: jacob.shaw@hca9.eclinicaldirectplus.com

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 1

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": "1564963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1376198614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16777 MEDICAL CENTER DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708163254",
            "telephone_number": "225-761-5200",
            "fax_number": "225-754-5052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16777 MEDICAL CENTER DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708163254",
            "telephone_number": "225-761-5200",
            "fax_number": "225-754-5052"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 4th St Ste 1D",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "LA",
            "postal_code": "713018421",
            "country_code": "US",
            "telephone_number": "318-443-4514",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "JACOB",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-05",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "320113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.