Jedidiah Andrew Jacobson, CPO

Primary specialty

OrthotistTaxonomy code 222Z00000X

License

CPO03265 Issued in CA

Practice address

2140 W Chapman Ave Ste 103
Orange, CA 92868-2331

Phone

(714) 602-6436

NPI assigned

Dec 27, 2017

Last updated

Mar 17, 2018By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Active Life, LLC

  • Prosthetic/Orthotic Supplier
  • Murrieta, CA
  • NPI 1174293997
  NPD (past)
• Active Life, LLC

  • Prosthetic/Orthotic Supplier
  • Orange, CA
  • NPI 1689942294
  NPD (past)

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

{
    "created_epoch": "1514332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1770099814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 W CHAPMAN AVE STE 103",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928682331",
            "telephone_number": "714-602-6436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 W CHAPMAN AVE STE 103",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928682331",
            "telephone_number": "714-602-6436"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6927 Brockton Ave Ste 2A",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925063807",
            "country_code": "US",
            "telephone_number": "951-224-9995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "JEDIDIAH",
        "middle_name": "ANDREW",
        "credential": "CPO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-27",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "CA",
            "license": "CPO03265",
            "primary": false
        },
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "CA",
            "license": "CPO03265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Briseida Jacobo
• Jeffrey A Jacobs, M.D.
• Samuel Jacobs
• Jared W. Jacobsen, D.D.S., M.S.
• Janet Carol Jacobson, MD
• Katherine Lee Jacoby, RN, CPNP
• Antony I Jacques
• Elena Lydia Jacquez
• Jade 8 LLC (Jade Guest Home)
• Jasmine Jadhav

• Orthotist in Orange, CA
• Providers in Orange, CA by specialty
• Orthotist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.