Active NPI
William A Jacobs, PA-C
- Physician Assistant
- Twin Falls, ID
National Provider Identifier
1679580377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-494
- Practice address
- 2550 Addison Ave E
Suite B
Twin Falls, ID 83301-6749 - Phone
- (208) 814-7700
- Fax
- (208) 933-9301
- NPI assigned
- Aug 2, 2006
- Last updated
- Oct 3, 2012
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-494 | ID | Primary |
Addresses
Primary practice location
2550 Addison Ave E
Suite B
Twin Falls, ID 83301-6749
Mailing address
PO Box 587
Twin Falls, ID 83303-0587
Phone (208) 814-7400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806903300 | Medicaid | ID |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-494 | ID | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Plateau Family Medicine, PS | Past | Accepting new patients | |
| U.S. Healthworks Medical Group of Washington, PS | Past | Accepting new patients | |
| St Luke's Magic Valley Regional Medical Center LTD | Past | Accepting new patients |
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.
-
dba St Lukes Retail Pharmacy Twin Falls
- Community/Retail Pharmacy
- Twin Falls, ID
- NPI 1760203921
-
- Family Medicine Physician
- Enumclaw, WA
- NPI 1033222146
-
- Urgent Care Clinic/Center
- Valencia, CA
- NPI 1407836208
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349222400000",
"number": "1679580377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 587",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833030587",
"telephone_number": "208-814-7400",
"fax_number": "208-814-7491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2550 ADDISON AVE E",
"address_2": "SUITE B",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833016749",
"telephone_number": "208-814-7700",
"fax_number": "208-933-9301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "WILLIAM",
"middle_name": "A",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2012-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA-494",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806903300",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Twin Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.