Active NPI
Jacob Plummer
- Student in an Organized Health Care Education/Training Program
- Plymouth, MN
National Provider Identifier
1780514893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1300 W Medicine Lake Dr Apt 219
Plymouth, MN 55441-4855 - Phone
- (763) 438-0065
- Fax
- (763) 438-0065
- NPI assigned
- May 20, 2026
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1300 W Medicine Lake Dr Apt 219
Plymouth, MN 55441-4855
Mailing address
1300 W Medicine Lake Dr Apt 219
Plymouth, MN 55441-4855
Phone (763) 438-0065
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1779235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779235200000",
"number": "1780514893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 W MEDICINE LAKE DR APT 219",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554414855",
"telephone_number": "763-438-0065",
"fax_number": "763-438-0065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 W MEDICINE LAKE DR APT 219",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554414855",
"telephone_number": "763-438-0065",
"fax_number": "763-438-0065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PLUMMER",
"first_name": "JACOB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-05-20",
"last_updated": "2026-05-20",
"certification_date": "2026-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
- Kara Elaine Pilon Reil, M.A., LPCC
- Pinnacle Chiropractic and Acupuncture, PA
- Pinnacle Dermatology, SC
- Jessica L. Pishney, PSYD, LP
- Laron Ploederer, D.C.
- Plymouth Chirocenter LLC
- Plymouth Dental Care PC
- Plymouth Family Dentistry, LLC
- Plymouth Grove Chiropractic, P.a.
- Plymouth Orthopedic Surgery Center LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.