Individual provider Active NPI

Kristian Jacobson, APRN

  • Family Nurse Practitioner
  • Wichita, KS
National Provider Identifier
1669248712
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
TMP-162073 Issued in KS
Practice address
3015 N Penstemon St
Wichita, KS 67226-3903
Phone
(316) 260-4110
NPI assigned
Nov 29, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X TMP-162073 KS Primary

Addresses

Primary practice location

3015 N Penstemon St
Wichita, KS 67226-3903

Mailing address

245 N Waco St Ste 220
Wichita, KS 67202-1102
Phone (316) 722-2138

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231223000143 KS Practitioner - Nurse Practitioner 5294185757 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.39 of 100Reported as group
Quality
87.87
Promoting interoperability
81
Improvement activities
40
Cost
77.51

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TMP-162073KSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hermes Healthcare PA CurrentSince Dec 6, 2023 Accepting new patients
House Call Medical Services CurrentSince Feb 15, 2025 Accepting new patients

Locations

3015 N Penstemon St
Wichita, KS 67226
Phone (316) 260-4110

245 N Waco St
Ste 220
Wichita, KS 67202
Phone (316) 722-2138

3343 W Central Ave
Wichita, KS 67203
Phone (316) 260-4110

Interoperability endpoints

  • Direct secure messaging: kristian.jacobson.1@26892.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/26892/brand/1/csg/1/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1701216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1669248712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 N WACO ST STE 220",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672021102",
            "telephone_number": "316-722-2138",
            "fax_number": "833-464-2530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 N PENSTEMON ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672263903",
            "telephone_number": "316-260-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "KRISTIAN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-29",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "TMP-162073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.