NPIMap

Individual provider Active NPI

Jacob Hunter Phillips, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Covington, LA
National Provider Identifier
1669094397
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
212776 Issued in LA
Practice address
95 Judge Tanner Blvd
Covington, LA 70433-7500
Phone
(985) 867-3800
Fax
(985) 867-3644
NPI assigned
May 15, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 903925 MS
Acute Care Nurse Practitioner 363LA2100X 212776 LA Primary

Addresses

Primary practice location

95 Judge Tanner Blvd
Covington, LA 70433-7500

Mailing address

PO Box 3370
Covington, LA 70434-3370
Phone (985) 867-8585

Other practice location 1

1900 Main St
Franklinton, LA 70438-3688
Phone (985) 795-4117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200722002848 LA Practitioner - Nurse Practitioner 4284058306 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gulfsouth Hospital Medicine LLCGroup PAC ID 6901151984, 14 clinicians
Nni Covington LLCGroup PAC ID 7517209364, 6 clinicians
Gulfsouth Pulmonology LLCGroup PAC ID 8325398696, 3 clinicians

Practice addresses (Care Compare)

1970 N Hwy 190
Covington, LA 70433-5364
Phone (985) 867-8585

Hospital & facility affiliations

  • East Jefferson General Hospital Hospital, Metairie, LA, CCN 190176
  • St Tammany Parish Hospital Hospital, Covington, LA, CCN 190045
  • Riverside Medical Center Hospital, Franklinton, LA, CCN 191313

Merit-based Incentive Payment System (MIPS)

Final score
90.75 of 100Reported as group
Quality
71.94
Promoting interoperability
100
Improvement activities
40
Cost
63.89

Merit-based Incentive Payment System (MIPS)

Final score
96.3 of 100Reported as group
Quality
85.77
Promoting interoperability
100
Improvement activities
40
Cost
68.58

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
212776LAMDAcute Care Nurse Practitioner
903925MSMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gulfsouth Pulmonology, LLC CurrentSince Jun 1, 2020 Accepting new patients
Riverside Emergency Physician Partners LLC CurrentSince May 15, 2021 Accepting new patients
Nni Covington LLC CurrentSince Jul 27, 2022 Accepting new patients
SLR Holdings LLC Acute Care CurrentSince Nov 1, 2024 Accepting new patients
Gulfsouth Hospital Medicine LLC CurrentSince Jun 1, 2020 Accepting new patients
Riverside Medical Center Current Accepting new patients
SLR Holdings LLC Current Accepting new patients
Frank J Arena MD, Apmc Past Accepting new patients
Northlake Nephrology Inc PastSince Aug 1, 2012 Accepting new patients

Locations

1415 Avenue F
Bogalusa, LA 70427
Phone (985) 735-1198

1970 N Highway 190
Ste 100
Covington, LA 70433

1970 N Highway 190
Covington, LA 70433
Phone (985) 400-5988

95 Judge Tanner Blvd
Covington, LA 70433
Phone (504) 867-3800

1970 N Highway 190
Ste C
Covington, LA 70433
Phone (985) 302-0470

1970 N Highway 190
Ste A
Covington, LA 70433

809 Riverside Dr
Franklinton, LA 70438
Phone (985) 795-4208

1900 Main St
Sheridan, LA 70438
Phone (985) 839-4431

Organizations & group practices 9

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1589500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1669094397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3370",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704343370",
            "telephone_number": "985-867-8585",
            "fax_number": "985-867-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 JUDGE TANNER BLVD",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704337500",
            "telephone_number": "985-867-3800",
            "fax_number": "985-867-3644"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Main St",
            "address_purpose": "LOCATION",
            "city": "Franklinton",
            "state": "LA",
            "postal_code": "704383688",
            "country_code": "US",
            "telephone_number": "985-795-4117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "JACOB",
        "middle_name": "HUNTER",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-15",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "903925",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "LA",
            "license": "212776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

Sources for this page

Verify at the official NPI Registry.