Jacob Smith, PA-C, ATC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085008559 Issued in IL

Practice address

1111 Trinity LN Ste 111
Bloomington, IL 61704-8112

Phone

(309) 663-6461

NPI assigned

Jun 24, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Carle West Physician Group IncGroup PAC ID 8921420308, 282 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carle Bromenn Medical Center Hospital, Normal, IL, CCN 140127

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jsmithpa336190@carlehiedirect.net

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.

• Carle Health Care Incorporated

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947
  Medicare reassignment Care Compare group NPD
• Carle West Physician Group Inc

  • Family Medicine Physician
  • Normal, IL
  • NPI 1467074138
  Medicare reassignment Care Compare group NPD
• Carle Eureka Hospital

  • Critical Access Hospital
  • Eureka, IL
  • NPI 1184644023
  Medicare reassignment NPD
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

• Carle Bromenn Medical Center

  • General Acute Care Hospital
  • Normal, IL
  • NPI 1962424036
  Care Compare affiliation

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1548675945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W. PARK ST.",
            "address_2": "FAPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 TRINITY LN STE 111",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617048112",
            "telephone_number": "309-663-6461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "PA-C, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-24",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085008559",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085008559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Smalltown Dental Bloomington on Maloney
• Smart Health & Wellness Center, LLC
• Barbarette Smith, LPC
• Elaine Smith, R.N.
• Glen B Smith, M.D.
• Jamie Smith, LCSW
• Joshua J Smith, PT
• Katrina Smith
• Maggie Kathleen Smith
• Savanah Smith

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; 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.