Active NPI
Jacob Gorham, MS, RD, LD, NASM-CPT
- Registered Dietitian
- State College, PA
National Provider Identifier
1396579967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 424 W Aaron Dr
State College, PA 16803-3043 - Phone
- (814) 234-1625
- NPI assigned
- Aug 27, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
424 W Aaron Dr
State College, PA 16803-3043
Mailing address
1000 W Aaron Dr Apt H07
State College, PA 16803-3151
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fitness Consultants Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724716800000",
"number": "1396579967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 W AARON DR APT H07",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168033151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "424 W AARON DR",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168033043",
"telephone_number": "814-234-1625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORHAM",
"first_name": "JACOB",
"credential": "MS, RD, LD, NASM-CPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-27",
"last_updated": "2024-08-27",
"certification_date": "2024-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in State College, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.