Jacob Jerdon, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

OP60653374 Issued in WA

Practice address

9040 Jackson Ave
Tacoma, WA 98431-2603

Phone

(253) 968-3885

NPI assigned

May 31, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Spokane Emergency Care Physicians PLLC

  • Emergency Medicine Physician
  • Spokane, WA
  • NPI 1912564055
  Medicare reassignment NPD

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1730526773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 S PROGRESS RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "990379313",
            "telephone_number": "760-646-1443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984312603",
            "telephone_number": "253-968-3885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 W 5th Ave",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992042803",
            "country_code": "US",
            "telephone_number": "509-473-7107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JERDON",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-31",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "OP60653374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seoung Rea Jeoung, RPH
• Lanae Jeppesen
• Janice Lynne Jepsen
• Jennifer Lynn Jepsen, PHARMD
• Shawn Arnell Jepsen, DMD
• Daniel Valentin Jereza, MD
• Amber Katelyn Jeromchek, OTD
• Tina Marie Jesse
• Leilani Ramirez Jessie
• Frederick Steven Jestrab, RPH

• Emergency Medicine Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Emergency Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.