Tad Jacobs, DO
Individual provider Active NPI Family Medicine Physician · Dell Rapids, SD
NPI 1629044458 · NPPES record last updated Jul 8, 2016
Key facts
- NPI
- 1629044458
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 1258 (SD)
- Practice address
- 111 E 10TH St
Dell Rapids, SD 57022-1217 - Phone
- (605) 997-2471
- Fax
- (605) 997-2418
- NPI assigned
- Feb 23, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1258 | SD | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera McKennan | Past | Accepting new patients | |
| Avera McKennan | Past | Accepting new patients |
Interoperability endpoints
- tad.jacobs@avera.sdhealthlink.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1258 | SD | Yes |
Addresses
Primary practice location
111 E 10TH St
Dell Rapids, SD 57022-1217
Mailing address
111 E 10TH St
Dell Rapids, SD 57022-1217
Phone (605) 428-5446
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 57028A004 | Other | SD | WPS TRICARE |
| 1258 | Other | SD | DAKOTACARE |
| 873765700 | Medicaid | MN | |
| 12967 | Other | SD | MIDLANDS CHOICE |
| 68890 | Other | SD | ARAZ/AMERICA'S PPO |
| AH908107523 | Other | SD | PREFERRED ONE |
| 5602007 | Medicaid | SD | |
| 4995979 | Other | SD | BCBS OF SOUTH DAKOTA |
| 659S6JA | Other | MN | BCBS OF MN |
| 659S 6JA | Other | MN | CC SYSTEMS BLUE PLUS |
| 5602006 | Medicaid | SD |
Other providers in Dell Rapids, SD
- Jeffery Todd Henry
- Matt E. Herber
- Rachel Houdek
- Howlin Vision Clinic, P.C.
- Joshua Hughes
- Michele Marie Johnson
- Abigail Kayser
- Vicki Kennedy
- Jonathan Koskela
- Rachel Kramer
All providers in Dell Rapids, SD · Family Medicine Physician in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.