Active NPI
Dustin A Jacot, PA
- Physician Assistant
- Crescent City, CA
National Provider Identifier
1699023077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA22461
- Practice address
- 550 E Washington Blvd
Crescent City, CA 95531-8160 - Phone
- (707) 465-6925
- Fax
- (707) 465-6070
- NPI assigned
- Aug 16, 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 | PA22461 | CA | Primary |
Addresses
Primary practice location
550 E Washington Blvd
Crescent City, CA 95531-8160
Mailing address
670 9TH St
Suite 203
Arcata, CA 95521-6248
Phone (707) 826-8633
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121002000248 | CA | Practitioner - Physician Assistant | 1153570452 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2200 Tydd St
Eureka, CA 95501-1284
Phone (707) 441-1624
550 E Washington Blvd
Crescent City, CA 95531-8160
Phone (707) 465-6925
Hospital & facility affiliations
- Sutter Coast Home Care
- Sutter Coast Hospital
- Curry General Hospital
- Providence St Joseph Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22461 | CA | MD | General Practice Dentistry |
| PA22461 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Viteledoc LLC | Current | Accepting new patients |
Locations
1275 8th St
Arcata, CA 95521
550 E Washington Blvd
Crescent City, CA 95531
Phone (707) 465-4636
550 E Washington Blvd
Ste 100
Crescent City, CA 95531
Phone (707) 465-6925
670 9th St
Ste 203
McKinleyville, CA 95521
Interoperability endpoints
- djacot25815@direct.ochin.org
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 and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Crescent City, CA
- NPI 1497840656
CA
-
- Family Medicine Physician
- Crescent City, CA
- NPI 1194434464
-
- Federally Qualified Health Center (FQHC)
- Eureka, CA
- NPI 1831713452
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Infusion Therapy Pharmacy
- Eureka, CA
- NPI 1568422319
Hospital
-
- General Acute Care Hospital
- Eureka, CA
- NPI 1609858950
Hospital
-
- General Acute Care Hospital
- Eureka, CA
- NPI 1891900635
Hospital
-
- Home Health Agency
- Crescent City, CA
- NPI 1609881499
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486684800000",
"number": "1699023077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 9TH ST",
"address_2": "SUITE 203",
"city": "ARCATA",
"state": "CA",
"postal_code": "955216248",
"telephone_number": "707-826-8633",
"fax_number": "707-826-8638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 E WASHINGTON BLVD",
"city": "CRESCENT CITY",
"state": "CA",
"postal_code": "955318160",
"telephone_number": "707-465-6925",
"fax_number": "707-465-6070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOT",
"first_name": "DUSTIN",
"middle_name": "A",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-16",
"last_updated": "2017-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA22461",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crescent City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2017; 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.