NPIMap

Organization Active NPI

Epic Systems Corporation Applied Informatics Physician

  • Private Vehicle
  • Honolulu, HI
National Provider Identifier
1568095503
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Private VehicleTaxonomy code 347C00000X
Legal business name
EPIC SYSTEMS CORPORATION APPLIED INFORMATICS PHYSICIAN
Practice address
229 Paoakalani Ave # 714
Honolulu, HI 96815-3764
Phone
(650) 253-0000
Fax
(650) 253-0001
NPI assigned
Feb 18, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Prof. Jacob Cornelius Parker, DONPI 1326510751
Title
Specialist Technologist
Phone
(650) 253-0000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Dental Clinic/Center 261QD0000X
Department of Veterans Affairs (VA) Pharmacy 332100000X
Private Vehicle 347C00000X Primary
Train 347D00000X

Addresses

Primary practice location

229 Paoakalani Ave # 714
Honolulu, HI 96815-3764

Mailing address

300 Fairway Dr
Hattiesburg, MS 39401-7715
Phone (650) 253-0000

Other practice location 1

2500 N State St
Jackson, MS 39216-4500
Phone (888) 815-2005

Other practice location 2

415 S 28th Ave
Hattiesburg, MS 39401-7283
Phone (601) 264-6000

Other identifiers 1

IdentifierTypeStateIssuer
314125401722MedicaidMS

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://simplifier.net/user/jacobcorneliusparker Direct
FHIR URL https://simplifier.net/user/jacobcorneliusparker Direct
Other URL https://1up.health/patient Direct

National Provider Directory

National Provider Directory
Tax ID family
Health Facility Laboratory5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1568095503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 FAIRWAY DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017715",
            "telephone_number": "650-253-0000",
            "fax_number": "650-253-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 PAOAKALANI AVE # 714",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968153764",
            "telephone_number": "650-253-0000",
            "fax_number": "650-253-0001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 N State St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164500",
            "country_code": "US",
            "telephone_number": "888-815-2005",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "415 S 28th Ave",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394017283",
            "country_code": "US",
            "telephone_number": "601-264-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EPIC SYSTEMS CORPORATION APPLIED INFORMATICS PHYSICIAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-18",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "CORNELIUS",
        "authorized_official_title_or_position": "SPECIALIST TECHNOLOGIST",
        "authorized_official_telephone_number": "650-253-0000",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332100000X",
            "taxonomy_group": "",
            "desc": "Department of Veterans Affairs (VA) Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "347D00000X",
            "taxonomy_group": "",
            "desc": "Train",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "314125401722",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://simplifier.net/user/jacobcorneliusparker",
            "affiliation": "Y",
            "endpointDescription": "Applications Organization",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "html",
            "address_1": "2500 N State St",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392164500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://simplifier.net/user/jacobcorneliusparker",
            "affiliation": "N",
            "endpointDescription": "Applications Organization",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "html",
            "address_1": "415 S 28th Ave",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394017283",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://1up.health/patient",
            "affiliation": "N",
            "endpointDescription": "Dr. Parker, Jacob Cornelius, MD. Application Description EMPLOYMENT Relational Technologies: San Jose, California, US 2018-08-27 to present",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "https://1up.health/patient",
            "address_1": "229 Paoakalani Ave # 714",
            "city": "Honolulu",
            "state": "HI",
            "country_code": "US",
            "postal_code": "968153764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.