Kevin S Jacobson, NP
Individual provider Active NPI Nurse Practitioner · Cooperstown, ND
NPI 1528093077 · NPPES record last updated May 23, 2012
Key facts
- NPI
- 1528093077
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- R27650 (ND)
- Practice address
- 1200 Roberts Ave NE
Cooperstown Medical Center
Cooperstown, ND 58425-7101 - Phone
- (701) 797-2128
- NPI assigned
- Jul 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Oakes Community Hospital
Practice addresses (Care Compare)
1200 N 7 St
Oakes, ND 58474-2502
Phone (701) 742-3600
Hospital & facility affiliations
- CHI Oakes Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070503000397 | ND | Practitioner - Nurse Practitioner | 7315043650 | Reassigns benefits to 3 organizations |
| I20190422000635 | MN | Practitioner - Nurse Practitioner | 7315043650 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 236 | ND | MD | Speech-Language Pathologist |
| R1561072 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oakes Community Hospital | Current |
Accepting new patients | |
| Lisbon Area Health Services | Current | Accepting new patients | |
| First Care Medical Services | Current |
Accepting new patients | |
| Bridges Medical Center | Current |
Accepting new patients | |
| First Care Medical Services | Current |
Accepting new patients | |
| Oakes Community Hospital | Current |
Accepting new patients | |
| Lisbon Area Health Services | Current |
Accepting new patients | |
| Bridges Medical Center | Current | Accepting new patients |
Locations
3276 Solutions Ctr
Chicago, IL 60677
201 9th St W
Ada, MN 56510
Phone (218) 784-2727
900 Hilligoss Blvd SE
Fosston, MN 56542
Phone (218) 435-1133
4784 Amber Valley Pkwy S
Fargo, ND 58104
1200 N 7th St
Oakes, ND 58474
Phone (701) 742-3291
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R1561072 | MN | |
| Nurse Practitioner | 363L00000X | R27650 | ND | Yes |
Addresses
Primary practice location
1200 Roberts Ave NE
Cooperstown Medical Center
Cooperstown, ND 58425-7101
Mailing address
1200 Roberts Ave NE
Cooperstown Medical Center
Cooperstown, ND 58425-7101
Phone (701) 797-2128
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19682 | Medicaid | ND |
Other providers in Cooperstown, ND
- Essential Chiropractic PLLC
- Brooke Leigh Fredrickson
- Griggs County
- Griggs County Nursing Home
- Cia Gronneberg
- Annette Robin Krabbenhoft
- Kali Susan Manz
- Kristine Louise Martin
- William G McKinnon
- Debra L. Middleton
All providers in Cooperstown, ND · Nurse Practitioner in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2012. 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.