Kevin S Jacobson, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R27650 Issued in ND

Practice address

1200 Roberts Ave NE
Cooperstown Medical Center
Cooperstown, ND 58425-7101

Phone

(701) 797-2128

NPI assigned

Jul 12, 2006

Last updated

May 23, 2012By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND, MN2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oakes Community HospitalGroup PAC ID 3678484722, shared by 4 NPIs, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI Oakes Hospital Hospital, Oakes, ND, CCN 351315

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Lisbon Area Health Services

  dba CHI Lisbon Health

  • Clinic/Center
  • Lisbon, ND
  • NPI 1811168958
  Medicare reassignment NPD
• Oakes Community Hospital

  dba CHI Oakes Hospital

  • Clinic/Center
  • Oakes, ND
  • NPI 1477724433
  Medicare reassignment NPD
• Oakes Community Hospital

  dba CHI Oakes Hospital

  • Critical Access Hospital
  • Oakes, ND
  • NPI 1598848517
  Medicare reassignment NPD
• Bridges Medical Center

  dba Essentia Health Ada Clinic

  • Rural Health Clinic/Center
  • Ada, MN
  • NPI 1366886186
  Medicare reassignment NPD
• First Care Medical Services

  dba Essentia Health Fosston Clinic

  • Critical Access Hospital Clinic/Center
  • Fosston, MN
  • NPI 1073638565
  Medicare reassignment NPD
• Lisbon Area Health Services

  dba CHI Lisbon Health

  • Clinic/Center
  • Lisbon, ND
  • NPI 1184051971
  NPD
• Bridges Medical Center

  dba Essentia Health Ada

  • Critical Access Hospital
  • Ada, MN
  • NPI 1306836598
  NPD
• First Care Medical Services

  dba Essentia Health Bagley Clinic

  • Rural Health Clinic/Center
  • Bagley, MN
  • NPI 1790861649
  NPD

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

• Oakes Community Hospital

  dba CHI Oakes Hospital

  • Critical Access Hospital
  • Oakes, ND
  • NPI 1598848517
  Care Compare affiliation

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337731200000",
    "number": "1528093077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 ROBERTS AVE NE",
            "address_2": "COOPERSTOWN MEDICAL CENTER",
            "city": "COOPERSTOWN",
            "state": "ND",
            "postal_code": "584257101",
            "telephone_number": "701-797-2128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 ROBERTS AVE NE",
            "address_2": "COOPERSTOWN MEDICAL CENTER",
            "city": "COOPERSTOWN",
            "state": "ND",
            "postal_code": "584257101",
            "telephone_number": "701-797-2128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "KEVIN",
        "middle_name": "S",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2012-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R1561072",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ND",
            "license": "R27650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19682",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Essential Chiropractic PLLC (Essential Chiropractic)
• Brooke Leigh Fredrickson, LRD, CSG
• Griggs County
• Griggs County Nursing Home (Griggs County Care Center)
• Cia Gronneberg
• Annette Robin Krabbenhoft
• Kali Susan Manz, CNP
• Kristine Louise Martin, APRN-CNP
• William G McKinnon, MD
• Debra L. Middleton, FNP

• Nurse Practitioner in Cooperstown, ND
• Providers in Cooperstown, ND by specialty
• Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2012; 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.