Jacob L. Lufkin, C.R.N.A.

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

57248 Issued in ID

Practice address

164 S 5TH St
Montpelier, ID 83254-1597

Phone

(208) 847-1630

NPI assigned

Feb 2, 2015

Last updated

Mar 23, 2020By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID, WY2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

Practice roles

Locations

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

  • Critical Access Hospital
  • Montpelier, ID
  • NPI 1336125533
  Medicare reassignment NPD
• Franklin County Medical Center

  dba FCMC Specialty Clinic

  • Critical Access Hospital
  • Preston, ID
  • NPI 1548355811
  Medicare reassignment NPD
• Oneida County Hospital

  • Critical Access Hospital
  • Malad, ID
  • NPI 1609826270
  Medicare reassignment NPD
• Community Hospital

  • Critical Access Hospital
  • Torrington, WY
  • NPI 1669410643
  Medicare reassignment NPD
• Bear Lake County Memorial Hospital

  dba Bear Lake Internal Medicine

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

  • Orthopaedic Surgery Physician
  • Montpelier, ID
  • NPI 1376871749
  NPD
• Franklin County Medical Center

  dba Franklin County Medical Center Home Health and Hospice

  • Home Health Agency
  • Preston, ID
  • NPI 1437927431
  NPD
• Oneida County Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Malad, ID
  • NPI 1568414167
  NPD
• Bear Lake County Memorial Hospital

  dba BLMH Bear Lake Clinic

  • Multi-Specialty Clinic/Center
  • Garden City, UT
  • NPI 1538916333
  NPD
• Bear Lake County Memorial Hospital

  dba Bear Lake Memorial Hospital Pharmacy

  • Critical Access Hospital
  • Montpelier, ID
  • NPI 1699814574
  NPD (past)

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

{
    "created_epoch": "1422835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584921600000",
    "number": "1457741167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 VALLEY VIEW DR",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "832541529",
            "telephone_number": "208-604-5009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 S 5TH ST",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "832541597",
            "telephone_number": "208-847-1630"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5734 Coventry Ln",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468047141",
            "country_code": "US",
            "telephone_number": "260-436-7875 x226",
            "fax_number": "260-432-9812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUFKIN",
        "first_name": "JACOB",
        "middle_name": "L.",
        "credential": "C.R.N.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-02",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28219682A",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "57248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilee Johnson, MRC, LPC
• Joseph F Decker Professional Corp
• Josh Bowman DC PLLC (Bowman Chiropractic)
• Angela K Kelly, LCSW
• Bobbi Jae Kelsey, LCSW
• Mary A McCarthy, LCSW
• Khristina Ashley Meissner, DO
• Modern Compounding Pharmacy
• Alex C Moss, PAC
• Brad Joseph Nelson, MSW, LMSW

• Certified Registered Nurse Anesthetist in Montpelier, ID
• Providers in Montpelier, ID by specialty
• Certified Registered Nurse Anesthetist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.