John Jacobs III, NP-C

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

34286.1346 Issued in WY

Practice address

3236 E Grand Ave Ste D
Laramie, WY 82070-5100

Phone

(307) 760-8602

Fax

(307) 460-9880

NPI assigned

Nov 1, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WY

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

Specialty

Nurse Practitioner

Education

Wright State University Boonshoft School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grand Avenue Urgent Care LLCGroup PAC ID 4385936244, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Regional West Medical Center Hospital, Scottsbluff, NE, CCN 280061
• Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Grand Avenue Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Laramie, WY
  • NPI 1174983118
  Medicare reassignment Care Compare group Authorized official
• Care United Medical Center of Laramie, LLC

  • Multi-Specialty Clinic/Center
  • Laramie, WY
  • NPI 1063720605
  Medicare reassignment NPD
• Grand Ave Family Medicine

  • Family Medicine Physician
  • Laramie, WY
  • NPI 1437842390
  NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Regional West Medical Center

  • General Acute Care Hospital
  • Scottsbluff, NE
  • NPI 1639101199
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1023965795
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  Care Compare affiliation

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

{
    "created_epoch": "1383264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542153600000",
    "number": "1497184378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3236 E GRAND AVE STE D",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705100",
            "telephone_number": "307-760-8602",
            "fax_number": "307-460-9880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3236 E GRAND AVE STE D",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705100",
            "telephone_number": "307-760-8602",
            "fax_number": "307-460-9880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "JOHN",
        "name_suffix": "III",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-01",
        "last_updated": "2018-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0990808-NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2259982",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "WY",
            "license": "34286.1346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P01679910",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Jackson
• Lani Jackson, CMT
• Patricia L Jackson, APRN
• Teresa J Jacobs Castano, LCSW LAT
• Eric Jacobs
• Aspen Jairell
• Mandy Jane Jairell, D.C.
• James a Boucher & Sue E Lowe PTR
• Melissa K James, MPT
• Shanna James

• Acute Care Nurse Practitioner in Laramie, WY
• Providers in Laramie, WY by specialty
• Acute Care Nurse Practitioner in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.