Jake A Davis, PA-C
Individual provider Active NPI Surgical Physician Assistant · Shenandoah, IA
NPI 1710380795 · NPPES record last updated Jan 28, 2026
Key facts
- NPI
- 1710380795
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- 074782 (IA)
- Practice address
- 300 Pershing Avvenue
Shenandoah, IA 51601 - Phone
- (712) 246-1230
- NPI assigned
- Oct 3, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Shenandoah Medical Center
Practice addresses (Care Compare)
1 Jack Foster Dr
Shenandoah, IA 51601-4586
Phone (712) 246-7240
300 Pershing Ave
Shenandoah, IA 51601-2355
Phone (712) 246-1230
Hospital & facility affiliations
- Shenandoah Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141103001130 | IA | Practitioner - Physician Assistant | 0244452431 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4820 | OK | MD | Neuromusculoskeletal Medicine & OMM Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shenandoah Medical Center | Current |
Accepting new patients | |
| Shenandoah Medical Center | Current | Accepting new patients | |
| Shenandoah Medical Center | Current | Accepting new patients |
Locations
300 Pershing Ave
Shenandoah, IA 51601
Phone (712) 246-1230
1 Jack Foster Dr
Shenandoah, IA 51601
Phone (712) 246-7240
Interoperability endpoints
- jakedavis@shenmed.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 074782 | IA | Yes |
Addresses
Primary practice location
300 Pershing Avvenue
Shenandoah, IA 51601
Mailing address
300 Pershing Avvenue
Shenandoah, IA 51601
Phone (712) 246-7101
Other providers in Shenandoah, IA
- Allen F Carrell
- Charles J Peterson DC PC
- Whitney Clayton
- James O Cloepfil
- Shala Davidson
- David Carroll Dickson
- Robert A Dostal
- Junaid Ebrahim
- Stephanie Eide
- Elite Braces Disgnostics LLC
All providers in Shenandoah, IA · Surgical Physician Assistant in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.