Active NPI
Jacob E Mefford, PA
- Physician Assistant
- Peoria, IL
National Provider Identifier
1689923013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085004403
- Practice address
- 221 NE Glen Oak Ave
Peoria, IL 61636-0001 - Phone
- (309) 672-5522
- NPI assigned
- Aug 30, 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 | 085004403 | IL | Primary |
Addresses
Primary practice location
221 NE Glen Oak Ave
Peoria, IL 61636-0001
Mailing address
Dept 960347
Oklahoma City, OK 73196-0347
Phone (800) 684-0062
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 |
|---|---|---|---|
| 085004403 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Methodist Medical Center of Illinois | Past | Accepting new patients | |
| Comprehensive Emergency Solutions SC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Peoria, IL
- NPI 1477515393
-
- Family Medicine Physician
- Peoria, IL
- NPI 1184670663
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359504000000",
"number": "1689923013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPT 960347",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731960347",
"telephone_number": "800-684-0062",
"fax_number": "405-844-1794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 NE GLEN OAK AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616360001",
"telephone_number": "309-672-5522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEFFORD",
"first_name": "JACOB",
"middle_name": "E",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-30",
"last_updated": "2013-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085004403",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.