Individual provider Active NPI

Grace L Jacobsen, PA

  • Physician Assistant
  • Anchorage, AK
National Provider Identifier
1801404579
Registry record updated Sep 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
209899 Issued in AK
Practice address
3841 Piper St Ste T100
Anchorage, AK 99508-4674
Phone
(907) 561-3211
Fax
(907) 771-6715
NPI assigned
Jul 20, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 209899 AK Primary

Addresses

Primary practice location

3841 Piper St Ste T100
Anchorage, AK 99508-4674

Mailing address

3841 Piper St Ste T100
Anchorage, AK 99508-4674
Phone (907) 550-2233

Other practice location 1

3643 N Roxboro St
Durham, NC 27704-2702
Phone (919) 470-4000

Other names 1

  • Grace L Johnson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230915002117 AK Practitioner - Physician Assistant 2769893817 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Duke University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alaska Heart InstituteGroup PAC ID 2668371469, 58 clinicians

Practice addresses (Care Compare)

2751 Debarr Rd
Suite B200
Anchorage, AK 99508-6813
Phone (907) 561-3211

2801 Debarr Rd
Anchorage, AK 99508-2932
Phone (907) 561-3211

3200 Providence Dr
Anchorage, AK 99508-4615
Phone (907) 561-3211

Hospital & facility affiliations

  • Providence Alaska Medical Center Hospital, Anchorage, AK, CCN 020001
  • Alaska Regional Hospital Hospital, Anchorage, AK, CCN 020017

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209899AKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Health System, Inc. CurrentSince Nov 16, 2020 Accepting new patients
Alaska Heart Institute CurrentSince Oct 2, 2023 Accepting new patients
Duke University Health System, Inc. CurrentSince Nov 16, 2020 Accepting new patients

Locations

3841 Piper St
Anchorage, AK 99508
Phone (907) 563-3103

3841 Piper St
Ste T100
Anchorage, AK 99508
Phone (907) 550-2233

2751 Debarr Rd
Ste B200
Anchorage, AK 99508

3125 E Meridian Park Loop
Ste 200
Wasilla, AK 99654

5213 S Alston Ave
Durham, NC 27713
Phone (919) 620-4700

3643 N Roxboro St
Durham, NC 27704
Phone (919) 470-6186

Organizations & group practices 3

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 2

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": "1595203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1801404579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 PIPER ST STE T100",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084674",
            "telephone_number": "907-550-2233",
            "fax_number": "907-771-6715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3841 PIPER ST STE T100",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084674",
            "telephone_number": "907-561-3211",
            "fax_number": "907-771-6715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3643 N Roxboro St",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277042702",
            "country_code": "US",
            "telephone_number": "919-470-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "GRACE",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-20",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "209899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "JOHNSON",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.