NPIMap

Individual provider Active NPI

Bethany Noelle Jacobs, PA-C

  • Physician Assistant
  • Millersville, PA
National Provider Identifier
1790294288
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA059393 Issued in PA
Practice address
15 Shenks LN
Millersville, PA 17551-1982
Phone
(717) 872-5444
Fax
(717) 872-1537
NPI assigned
Sep 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA
Physician Assistant 363A00000X MA059393 PA Primary

Addresses

Primary practice location

15 Shenks LN
Millersville, PA 17551-1982

Mailing address

500 University Dr
MC Ca410
Hershey, PA 17033-2360
Phone (800) 243-1455

Other practice location 1

2112 Harrisburg Pike
Lancaster, PA 17601-2644
Phone (717) 431-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20180123000693 PA Practitioner - Physician Assistant 9739448614 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penn State Health Medical Group LLCGroup PAC ID 8729351077, 720 clinicians

Practice addresses (Care Compare)

1120 Cocoa Ave
Hershey, PA 17033-1712
Phone (717) 533-4141

2221 Noll Dr
Suite 2000
Lancaster, PA 17603-7614
Phone (717) 715-1001

Hospital & facility affiliations

  • Penn State Health St. Joseph Hospital, Reading, PA, CCN 390096
  • Lancaster General Hospital Hospital, Lancaster, PA, CCN 390100
  • Milton S Hershey Medical Center Hospital, Hershey, PA, CCN 390256
  • Upmc Lititz Hospital, Lititz, PA, CCN 390068
  • Penn State Health Lancaster Medical Center Hospital, Lancaster, PA, CCN 390339

Merit-based Incentive Payment System (MIPS)

Final score
82.85 of 100Reported as group
Quality
65.84
Promoting interoperability
100
Improvement activities
40
Cost
77

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Stephen G. Diamantoni, MD and Associates Family Practice CurrentSince Dec 6, 2017 Accepting new patients
Stephen Diamantoni & Associates Family Practice PC CurrentSince Dec 6, 2017 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Jan 1, 2022 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Jan 1, 2022 Accepting new patients
Penn State Health Medical Group, LLC Past Accepting new patients

Locations

500 University Dr
#410
Hershey, PA 17033
Phone (717) 531-1159

1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141

2160 State Rd
Ste 1820
Lancaster, PA 17601
Phone (223) 287-8160

734 N Franklin St
Lancaster, PA 17602
Phone (717) 295-2323

2112 Harrisburg Pike
Ste 3
Lancaster, PA 17601
Phone (717) 431-3000

2112 Harrisburg Pike
Lancaster, PA 17601
Phone (717) 431-3000

15 Shenks Ln
Millersville, PA 17551
Phone (717) 872-5444

16 Manor Ave
Ste A
Millersville, PA 17551
Phone (717) 872-0901

Interoperability endpoints

  • Direct secure messaging: bjacobs@diamantoni.directbygreenway.com

Organizations & group practices 7

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.

Hospital & facility affiliations 8

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": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1790294288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 UNIVERSITY DR",
            "address_2": "MC CA410",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332360",
            "telephone_number": "800-243-1455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 SHENKS LN",
            "city": "MILLERSVILLE",
            "state": "PA",
            "postal_code": "175511982",
            "telephone_number": "717-872-5444",
            "fax_number": "717-872-1537"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2112 Harrisburg Pike",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176012644",
            "country_code": "US",
            "telephone_number": "717-431-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "BETHANY",
        "middle_name": "NOELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-27",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA059393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millersville, PA

Sources for this page

Verify at the official NPI Registry.