Active NPI
Loren Henning Jacobsen, MD
- Family Medicine Physician
- Broken Bow, NE
National Provider Identifier
1609937598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 11678
- Practice address
- 145 Memorial Dr
Broken Bow, NE 68822-1378 - Phone
- (308) 872-2486
- Fax
- (308) 872-2027
- NPI assigned
- Dec 13, 2006
- Last updated
- Jul 13, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 11678 | NE | Primary |
Addresses
Primary practice location
145 Memorial Dr
Broken Bow, NE 68822-1378
Mailing address
PO Box 690
Broken Bow, NE 68822-0690
Phone (308) 872-6283
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11678 | NE | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184284800000",
"number": "1609937598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 690",
"city": "BROKEN BOW",
"state": "NE",
"postal_code": "688220690",
"telephone_number": "308-872-6283",
"fax_number": "308-872-2027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 MEMORIAL DR",
"city": "BROKEN BOW",
"state": "NE",
"postal_code": "688221378",
"telephone_number": "308-872-2486",
"fax_number": "308-872-2027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSEN",
"first_name": "LOREN",
"middle_name": "HENNING",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-13",
"last_updated": "2007-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NE",
"license": "11678",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Bow, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.