Active NPI
Ryan Blaine Jacobsen, PHARMD
- Pharmacist
- Iowa City, IA
National Provider Identifier
1750427563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19711
- Practice address
- 200 Hawkins Dr
Cc101 GH Pharmacy
Iowa City, IA 52242-1009 - Phone
- (319) 356-2577
- NPI assigned
- Jan 29, 2007
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19711 | IA | Primary |
Addresses
Primary practice location
200 Hawkins Dr
Cc101 GH Pharmacy
Iowa City, IA 52242-1009
Mailing address
90 Andrea CT
Iowa City, IA 52246-4189
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)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19711 | IA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State University of Iowa | Past | Accepting new patients | |
| State University of Iowa | 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.
-
dba University of Iowa Health Care
- Family Medicine Physician
- Iowa City, IA
- NPI 1477554814
-
dba University of Iowa Hospitals & Clinics/Ambulatory Care Pharmacy
- Pharmacy
- Iowa City, IA
- NPI 1508858127
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750427563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 ANDREA CT",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522464189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HAWKINS DR",
"address_2": "CC101 GH PHARMACY",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522421009",
"telephone_number": "319-356-2577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSEN",
"first_name": "RYAN",
"middle_name": "BLAINE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "19711",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Iowa City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.