Jacob L. Lufkin, C.R.N.A.
Individual provider Active NPI Certified Registered Nurse Anesthetist · Montpelier, ID
NPI 1457741167 · NPPES record last updated Mar 23, 2020
Key facts
- NPI
- 1457741167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 57248 (ID)
- Practice address
- 164 S 5TH St
Montpelier, ID 83254-1597 - Phone
- (208) 847-1630
- NPI assigned
- Feb 2, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID, WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220728001206 | ID | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 4082931324 | Reassigns benefits to 4 organizations |
| I20230920000427 | WY | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 4082931324 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oneida County Hospital | Current |
Accepting new patients | |
| Franklin County Medical Center | Current |
Accepting new patients | |
| Bear Lake County Memorial Hospital | Current |
Accepting new patients | |
| Bear Lake County Memorial Hospital | Current |
Accepting new patients | |
| Oneida County Hospital | Current |
Accepting new patients | |
| Bear Lake County Memorial Hospital | Current |
Accepting new patients | |
| Franklin County Medical Center | Current |
Accepting new patients | |
| Community Hospital | Current | Accepting new patients | |
| Bear Lake County Memorial Hospital | Past | Accepting new patients |
Locations
2901 N Central Ave
Ste 160
Phoenix, AZ 85012
Phone (520) 481-4280
150 N 200 W
Malad City, ID 83252
Phone (208) 766-2231
164 S 5th St
Montpelier, ID 83254
Phone (208) 847-1630
822 Washington St
Montpelier, ID 83254
Phone (208) 847-4404
44 N 1st E
Preston, ID 83263
Phone (208) 852-0137
2000 Campbell Dr
Torrington, WY 82240
Phone (307) 532-4181
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28219682A | IN | |
| Certified Registered Nurse Anesthetist | 367500000X | 57248 | ID | Yes |
Addresses
Primary practice location
164 S 5TH St
Montpelier, ID 83254-1597
Mailing address
123 Valley View Dr
Montpelier, ID 83254-1529
Phone (208) 604-5009
Other practice location 1
5734 Coventry Ln
Fort Wayne, IN 46804-7141
Phone (260) 436-7875 ext. 226
Other providers in Montpelier, ID
- Marilee Johnson
- Joseph F Decker Professional Corp
- Josh Bowman DC PLLC
- Angela K Kelly
- Bobbi Jae Kelsey
- Mary A McCarthy
- Khristina Ashley Meissner
- Modern Compounding Pharmacy
- Alex C Moss
- Brad Joseph Nelson
All providers in Montpelier, ID · Certified Registered Nurse Anesthetist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.