Jacob Wilson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

733279 Issued in AZ

Practice address

2033-1 N Spruce
Tuba City, AZ 86045

Phone

(602) 576-2812

NPI assigned

Jun 8, 2023

Sex

Male

Sole proprietor

Yes

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 TX, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tuba City Regional Health Care CorporationGroup PAC ID 4284542531, 160 clinicians

Marshall B Ketchum UniversityGroup PAC ID 9739075177, 56 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tuba City Regional Health Care Corporation Hospital, Tuba City, AZ, CCN 030073

Merit-based Incentive Payment System (MIPS)

Final score

77.59 of 100Reported as group

Quality

47.51

Promoting interoperability

69

Improvement activities

40

Cost

86.96

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Tuba City Regional Health Care Corporation

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1548294424

  TX

  Medicare reassignment Care Compare group NPD
• Marshall B. Ketchum University

  • Optometrist
  • Anaheim, CA
  • NPI 1720101876
  Medicare reassignment Care Compare group NPD
• Tuba City Regional Health Care Corporation

  • Family Medicine Physician
  • Bodaway Gap, AZ
  • NPI 1710519913
  NPD
• Marshall B. Ketchum University

  • Multi-Specialty Clinic/Center
  • Anaheim, CA
  • NPI 1174037493
  NPD
• Marshall B. Ketchum University/University Eye Center at Los Angeles

  • Optometrist
  • Los Angeles, CA
  • NPI 1558467225
  NPD

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

• Tuba City Regional Health Care Corporation

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1548294424
  Care Compare affiliation

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

{
    "created_epoch": "1686182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1740974088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 N MAIN ST",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "86045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033-1 N SPRUCE",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "86045",
            "telephone_number": "602-576-2812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACOB",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-08",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "733279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol A. Williamson
• Dawn D Williamson, RN
• Sheryl H. Willie, CNA
• Amy Starr Wilson, RN
• Cindy Jo Wilson, CNA
• Janice Wilson, RN
• Marlana Wilson, CNA
• Phyllis J Winans, RN
• Arline C Winfield, CRNA
• Philip Anders Wixom, MD

• Optometrist in Tuba City, AZ
• Providers in Tuba City, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; 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.