Kelli A. Jacob, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP05911 Issued in LA

Practice address

2300 Hospital Dr
Suite 360
Bossier City, LA 71111-2394

Phone

(318) 212-7902

Fax

(318) 212-7905

NPI assigned

Oct 21, 2009

Sex

Female

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 LA

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

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Louisiana Nephrology, LLCGroup PAC ID 7911996509, 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111
• North Caddo Medical Center Hospital, Vivian, LA, CCN 191304
• Desoto Regional Health System Hospital, Mansfield, LA, CCN 190118

Merit-based Incentive Payment System (MIPS)

Final score

88.02 of 100Reported as group

Quality

66.64

Promoting interoperability

100

Improvement activities

40

Cost

70.28

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kellijacob@nln.allscriptsdirect.net

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.

• Northwest Louisiana Nephrology, LLC

  • Nephrology Physician
  • Shreveport, LA
  • NPI 1669416491
  Medicare reassignment Care Compare group NPD
• Laura Kimball-Ravari MD and Willis-Knighton Medical Center

  • Endocrinology, Diabetes & Metabolism Physician
  • Bossier City, LA
  • NPI 1780610824
  NPD (past)

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

• Desoto Hospital Association

  • General Acute Care Hospital
  • Mansfield, LA
  • NPI 1467455154
  Care Compare affiliation
• North Caddo Hospital Service District

  • Critical Access Hospital
  • Vivian, LA
  • NPI 1326016684
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Bossier City, LA
  • NPI 1003968579
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1124170691
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1275685539
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572
  Care Compare affiliation

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

{
    "created_epoch": "1256083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256601600000",
    "number": "1679809933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 HOSPITAL DR",
            "address_2": "SUITE 360",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112394",
            "telephone_number": "318-212-7902",
            "fax_number": "318-212-7905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 HOSPITAL DR",
            "address_2": "SUITE 360",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112394",
            "telephone_number": "318-212-7902",
            "fax_number": "318-212-7905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "KELLI",
        "middle_name": "A.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-21",
        "last_updated": "2009-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "AP05911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paige Hewlett Jackson, PA-C
• Rhonda Jackson
• Sarah Myers Jackson, P.T.
• Skylar Jackson
• Stephanie Jackson
• Keondra Jacobs
• Lavonda Jacobs, REGISTERED NURSE
• Sarmand Sardar Jameel, MD
• Joseph James Jr.
• Dishau Jeanjacques

• Nurse Practitioner in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2009; 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.