NPIMap

Individual provider Active NPI

William C Jacobson, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Des Moines, IA
National Provider Identifier
1790749448
Registry record updated Jan 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
33389 Issued in IA
Practice address
12499 University Ave
Suite 210
Des Moines, IA 50325-8281
Phone
(515) 440-2676
Fax
(515) 440-2677
NPI assigned
Apr 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 33389 IA Primary

Addresses

Primary practice location

12499 University Ave
Suite 210
Des Moines, IA 50325-8281

Mailing address

12499 University Ave
Suite 210
Des Moines, IA 50325-8281
Phone (515) 440-2676

Other identifiers 3

IdentifierTypeStateIssuer
200044900OtherIARAILROAD MEDICARE
43972OtherBLUE CROSS BLUE SHIELD
2205187MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20040324000295 IA Practitioner - Orthopedic Surgery 3678464096 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Iowa, RJ & L Carver College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capital Orthopaedics and Sports Medicine PCGroup PAC ID 3476691551, 19 clinicians
Broadlawns Medical CenterGroup PAC ID 3678466166, 302 clinicians

Practice addresses (Care Compare)

12499 University Ave
Suite 210
Clive, IA 50325-8288
Phone (515) 440-2676

1801 Hickman Rd
Des Moines, IA 50314-1548
Phone (515) 282-2200

Hospital & facility affiliations

  • Mercyone Des Moines Medical Center Hospital, Des Moines, IA, CCN 160083
  • Broadlawns Medical Center Hospital, Des Moines, IA, CCN 160101
  • Unitypoint Health - Des Moines Iowa Methodist Medi Hospital, Des Moines, IA, CCN 160082

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement22
Lower limb (leg) arthroscopy (minimally invasive joint repair)16
Upper limb (arm) arthroscopy (minimally invasive joint repair)59

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
33389IAMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Capital Orthopaedics and Sports Medicine PC Sports Medicine CurrentSince Jan 1, 2010 Accepting new patients
Broadlawns Medical Center CurrentSince Jan 26, 2025 Accepting new patients
Broadlawns Medical Center CurrentSince Jan 26, 2025 Accepting new patients
Scott B Neff Dopc Past Accepting new patients
Donald D Berg MD PC Past Accepting new patients
Capital Orthopaedics and Sports Medicine LLP Past Accepting new patients
William C. Jacobson MD PC Sports Medicine PastSince Mar 23, 2004 Accepting new patients

Locations

12499 University Ave
Ste 210
Des Moines, IA 50325
Phone (515) 240-2676

1801 Hickman Rd
Des Moines, IA 50314
Phone (515) 282-2200

1601 NW 114th St
Ste 142
Des Moines, IA 50325
Phone (515) 222-3151

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19659/brand/1/csg/1/fhir/r4
  • Direct secure messaging: wjacabson3948173@direct.trinity-health.org
  • Direct secure messaging: william.jacobson.1@19659.direct.athenahealth.com

Organizations & group practices 8

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": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358812800000",
    "number": "1790749448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12499 UNIVERSITY AVE",
            "address_2": "SUITE 210",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503258281",
            "telephone_number": "515-440-2676",
            "fax_number": "515-440-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12499 UNIVERSITY AVE",
            "address_2": "SUITE 210",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503258281",
            "telephone_number": "515-440-2676",
            "fax_number": "515-440-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "WILLIAM",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-12",
        "last_updated": "2013-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "IA",
            "license": "33389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "200044900",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "43972",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2205187",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.