Jacob William McDougall, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12689705-1206 Issued in UT

Practice address

162 Legacy Oaks Dr
Knightdale, NC 27545-6556

Phone

(919) 373-1800

NPI assigned

Jan 5, 2017

Last updated

Oct 26, 2022By 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 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmcdougall588634@direct.med.utah.edu

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.

• Duke University Affiliated Physicians, Inc.

  dba Duke Urgent Care

  • Emergency Medicine Physician
  • Raleigh, NC
  • NPI 1710120795
  NPD
• Duke University Affiliated Physicians, Inc.

  dba Duke Urgent Care Hillsborough

  • Family Medicine Physician
  • Hillsborough, NC
  • NPI 1801338272
  NPD
• University of Utah Adult Services

  dba University of Utah Hospital Radiology Department

  • Diagnostic Radiology Physician
  • Salt Lake City, UT
  • NPI 1598169419
  NPD
• University of Utah Adult Services

  dba Internal Medicine- Hepatology-Department of University of Utah

  • Hepatology Physician
  • Salt Lake City, UT
  • NPI 1780088583
  NPD
• University of Utah Pediatric Services

  dba Pediatric Infectious Disease

  • Pediatric Infectious Diseases Physician
  • Salt Lake City, UT
  • NPI 1285098855
  NPD
• University of Utah Pediatric Services

  dba Pediatric Diagnostic Cardiology

  • Pediatric Cardiology Physician
  • Salt Lake City, UT
  • NPI 1902260474
  NPD
• Fastmed P.C.

  • Family Medicine Physician
  • Durham, NC
  • NPI 1629841788
  NPD (past)
• Uncommon Care PA

  • Urgent Care Clinic/Center
  • Angier, NC
  • NPI 1659517993
  NPD (past)

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

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1801331467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 E GANNON AVE",
            "address_2": "SUITE #104",
            "city": "ZEBULON",
            "state": "NC",
            "postal_code": "275979309",
            "telephone_number": "919-375-1975",
            "fax_number": "919-269-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 LEGACY OAKS DR",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275456556",
            "telephone_number": "919-373-1800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "817 E Gannon Ave",
            "address_2": "FastMed",
            "address_purpose": "LOCATION",
            "city": "Zebulon",
            "state": "NC",
            "postal_code": "275979350",
            "country_code": "US",
            "telephone_number": "919-550-0821",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9633 Bitter Melon Dr",
            "address_purpose": "LOCATION",
            "city": "Angier",
            "state": "NC",
            "postal_code": "275015917",
            "country_code": "US",
            "telephone_number": "919-639-8900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDOUGALL",
        "first_name": "JACOB",
        "middle_name": "WILLIAM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-05",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06933",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "12689705-1206",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "12689705-8906",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JMCDOUGALL588634@DIRECT.MED.UTAH.EDU",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sonja K Martin, L.P.C.
• Suzanne L Masters, FNP
• Carmelesha Angelette Matthewson, C.HAIRLOSSPECIALIST
• Dona D Mayo, MS, LPC
• McCullers Delivery Service (MDS Transport)
• Destiny McDuffie, OD
• Kellen Reis McGeorge
• Katherine Suzanne McGowan, DPT
• Diedra S. McGuire, DDS
• Shakeria E McGuire, MSW, LCSW

• Physician Assistant in Knightdale, NC
• Providers in Knightdale, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.