Jacob Leon Callison, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1844 Issued in OK

Practice address

5050 E Kenosha St
Broken Arrow, OK 74014-6711

Phone

(918) 994-5140

Fax

(918) 994-5150

NPI assigned

Aug 3, 2009

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2016 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/7102/brand/2/csg/1/fhir/r4
• Direct secure messaging: jacob.callison.1@7102.direct.athenahealth.com

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.

• Broken Arrow Diagnostic Medicine, PLLC

  • Family Medicine Physician
  • Broken Arrow, OK
  • NPI 1710322672
  NPD Authorized official
• Northeast Oklahoma Physician Network Inc

  • Urgent Care Clinic/Center
  • Broken Arrow, OK
  • NPI 1205190501
  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

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

{
    "created_epoch": "1249257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1487885877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 E KENOSHA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740146711",
            "telephone_number": "918-994-5140",
            "fax_number": "918-994-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 E KENOSHA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740146711",
            "telephone_number": "918-994-5140",
            "fax_number": "918-994-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLISON",
        "first_name": "JACOB",
        "middle_name": "LEON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-03",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caldwell Medical Group, PLLC
• Alexus Montoya Caldwell
• Caitlyn Rex Caldwell, DPT
• Catherine Calibey
• Misty Calico, RBT
• Marlita Camacho, CPM, LM
• Jessica Lynn Cameron, PHARMD
• Alina Campbell
• Brittany Campbell, BCBA
• Elizabeth Dawn Campbell, D.O.

• Physician Assistant in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.