Jacob Clawson, MD
Individual provider Active NPI Anatomic Pathology & Clinical Pathology Physician · Blackfoot, ID
NPI 1497917728 · NPPES record last updated Mar 10, 2023
Key facts
- NPI
- 1497917728
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- License
- 25611 (NE)
- Practice address
- 98 Poplar St
Blackfoot, ID 83221-1758 - Phone
- (208) 782-2475
- Fax
- (208) 782-2476
- NPI assigned
- Jun 27, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Medicare Care Compare profile
- Specialty
- Pathology
- Education
- Uniformed Services Uhs Fe Hebert School of Med, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- BMH Inc
Practice addresses (Care Compare)
315 W Idaho St
Blackfoot, ID 83221-1711
Phone (208) 782-3990
98 Poplar St
Blackfoot, ID 83221-1758
Phone (208) 785-4100
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190204000347 | ID | Practitioner - Pathology | 1658618392 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25611 | NE | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Caribou Medical Center, Inc | Current |
Accepting new patients | |
| Idaho Pathology Laboratory Physicians | Current | Accepting new patients | |
| Caribou Medical Center, Inc | Current |
Accepting new patients | |
| BMH, Inc. | Current |
Accepting new patients | |
| BMH, Inc. | Current |
Accepting new patients |
Locations
315 W Idaho St
Blackfoot, ID 83221
Phone (208) 782-3990
98 Poplar St
Blackfoot, ID 83221
Phone (208) 782-3763
777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000
300 S 3rd W
Soda Springs, ID 83276
Phone (208) 547-0700
Interoperability endpoints
- jclawson637627@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 25611 | NE | Yes |
Addresses
Primary practice location
98 Poplar St
Blackfoot, ID 83221-1758
Mailing address
98 Poplar St
Blackfoot, ID 83221-1758
Phone (208) 782-2475
Other providers in Blackfoot, ID
- Childrens Supportive Services Incorporated
- Childrens Supportive Services Incorporated
- Christine Christensen
- City of Blackfoot
- City of Blackfoot
- Shanna Clayson
- Steven J Clinger
- Ronda Marie Cody
- Comfort Home Care
- Community Council of Idaho, Inc
All providers in Blackfoot, ID · Anatomic Pathology & Clinical Pathology Physician 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 10, 2023. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.