Andre Jack Jacobsen

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

200882 Issued in AK

Practice address

3300 Providence Dr Ste 205
Anchorage, AK 99508-4620

Phone

(907) 561-1510

NPI assigned

Apr 3, 2018

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

Medicare fee-for-service enrollment

Enrolled in AK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

Medical College of Wisconsin, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Anchorage Anesthesia Medical Group PCGroup PAC ID 2163414830, 52 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Alaska Medical Center Hospital, Anchorage, AK, CCN 020001

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Providence Anchorage Anesthesia Medical Group, P.C.

  • Anesthesiology Physician
  • Anchorage, AK
  • NPI 1659368397
  Medicare reassignment Care Compare group NPD
• University Hospitals Medical Group Inc

  • Multi-Specialty Clinic/Center
  • Cleveland, OH
  • NPI 1669499414

  Anesthesiology

  NPD (past)

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

• Providence Health & Services Washington

  • General Acute Care Hospital
  • Anchorage, AK
  • NPI 1053363119
  Care Compare affiliation

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1629574223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 PROVIDENCE DR STE 205",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084620",
            "telephone_number": "907-561-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 PROVIDENCE DR STE 205",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084620",
            "telephone_number": "907-561-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "ANDRE",
        "middle_name": "JACK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AK",
            "license": "200882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia J Jacobs
• Carl Jacobs
• Chelsey D Jacobs, PA-C
• Michael Ralph Jacobs
• Rebecca Jacobs, MS
• Grace L Jacobsen, PA
• Loren J Jacobsen
• Emma Jessica Jacobson
• Molly Katherine Jacobson
• Jade Acupuncture and Behavioral Health LLC

• Anesthesiology Physician in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Anesthesiology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; 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.