NPIMap

Individual provider Active NPI

Jacob C Neibaur, PA-C

  • Medical Physician Assistant
  • Las Vegas, NV
National Provider Identifier
1770851602
Registry record updated Jul 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA1313 Issued in NV
Practice address
6276 S Rainbow Blvd
#100
Las Vegas, NV 89118-3242
Phone
(702) 396-4165
NPI assigned
Dec 7, 2011
Last updated
Jul 7, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA1313 NV Primary

Addresses

Primary practice location

6276 S Rainbow Blvd
#100
Las Vegas, NV 89118-3242

Mailing address

6276 S Rainbow Blvd
#100
Las Vegas, NV 89118-3242
Phone (702) 396-4165

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120111000835 NV Practitioner - Physician Assistant 3971770124 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Infectious Disease Specialists LLCGroup PAC ID 7214974971, 12 clinicians

Practice addresses (Care Compare)

6867 W Charleston Blvd
Suite 100
Las Vegas, NV 89117-1669
Phone (702) 396-4165

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92 of 100Reported as group
Quality
100
Improvement activities
40
Cost
40.01

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Medical Associates, Inc CurrentSince May 15, 2017 Accepting new patients
Mouchir S Harb MD LTD PastSince Jun 15, 2019 Accepting new patients
Valley Primary Care Center LLC PastSince Nov 28, 2021 Accepting new patients

Locations

2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1323216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373155200000",
    "number": "1770851602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6276 S RAINBOW BLVD",
            "address_2": "#100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891183242",
            "telephone_number": "702-396-4165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6276 S RAINBOW BLVD",
            "address_2": "#100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891183242",
            "telephone_number": "702-396-4165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEIBAUR",
        "first_name": "JACOB",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-07",
        "last_updated": "2013-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA1313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.