Justin Jacobson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-005085 Issued in IL

Practice address

1340 Charles St Ste 100
Rockford, IL 61104

Phone

(779) 696-1900

NPI assigned

May 5, 2014

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Swedishamerican HospitalGroup PAC ID 5799698346, 386 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uw Health Hospital, Rockford, IL, CCN 140228

Merit-based Incentive Payment System (MIPS)

Final score

81.51 of 100Reported as group

Quality

83.2

Promoting interoperability

77

Improvement activities

40

Cost

71.7

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Swedishamerican Hospital

  dba SwedishAmerican Medical Group

  • Family Medicine Physician
  • Rockford, IL
  • NPI 1962451732
  Medicare reassignment Care Compare group NPD (past)
• Physicians Immediate Care North Chicago LLC

  • Urgent Care Clinic/Center
  • Chicago, IL
  • NPI 1205814118
  Medicare reassignment
• Swedishamerican Hospital

  • Community/Retail Pharmacy
  • Rockford, IL
  • NPI 1306635982
  NPD
• Swedishamerican Hospital

  • Pulmonary Disease Physician
  • Rockford, IL
  • NPI 1326193061
  NPD
• Pic Wisconsin SC

  dba Physicians Urgent Care

  • Urgent Care Clinic/Center
  • Brookfield, WI
  • NPI 1124678354
  NPD (past)

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

• Swedishamerican Hospital

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1760542732
  Care Compare affiliation

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

{
    "created_epoch": "1399248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1528478104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 CHARLES ST STE 100",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61104",
            "telephone_number": "779-696-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "JUSTIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-05",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-005085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jjacobson911715@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "1340 Charles St Ste 100",
            "city": "Rockford",
            "state": "IL",
            "country_code": "US",
            "postal_code": "61104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dmeka Jackson
• Jill A Jackson, PT
• Neha Jackson
• Mark Kevin Jacob, M.D.
• Abbey Jacobson, CNM
• Lindsey Jacobson, PTA
• Tracy Jacobson, NP
• Richard L Jaconette, MD
• Jacque Ruch LCSW, LTD.
• Jacque Ruch LCSW, LTD.

• Physician Assistant in Rockford, IL
• Providers in Rockford, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; 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.