NPIMap

Individual provider Active NPI

Elisabeth Doran Jacobs, M.D.

  • Family Medicine Physician
  • Lynnwood, WA
National Provider Identifier
1831246966
Registry record updated Apr 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60117921 Issued in WA
Practice address
20200 54TH Ave W
Lynnwood, WA 98036-6318
Phone
(425) 672-6518
Fax
(425) 672-6518
NPI assigned
Jan 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A75610 CA
Family Medicine Physician 207Q00000X MD60117921 WA Primary

Addresses

Primary practice location

20200 54TH Ave W
Lynnwood, WA 98036-6318

Mailing address

20200 54TH Ave W
Lynnwood, WA 98036-6318
Phone (425) 672-6518

Other practice location 1

1441 Constitution Blvd
Building 500
Salinas, CA 93906-3100
Phone (831) 755-4373

Other identifiers 1

IdentifierTypeStateIssuer
00A756100MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, AK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101129000526 WA Practitioner - Family Practice 4789778770 Reassigns benefits to 1 organization
I20231206002613 AK Practitioner - Family Practice 4789778770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oregon Health Sciences University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Valley Medical Care PCGroup PAC ID 6103818307, 15 clinicians

Practice addresses (Care Compare)

1801 Salmon Creek LN
Juneau, AK 99801-7864
Phone (907) 586-2434

Hospital & facility affiliations

  • Bartlett Home Health and Hospice Home health agency, Juneau, AK, CCN 027305
  • Bartlett Regional Hospital Hospital, Juneau, AK, CCN 020008
  • Southeast Alaska Regional Health Consortium Hospital, Sitka, AK, CCN 021314

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A75610CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington Family Medicine CurrentSince Sep 12, 2010 Accepting new patients
Valley Medical Care PC Family Medicine CurrentSince Nov 1, 2023 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Sep 12, 2010 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients
Monterey County Behavioral Health Division Past Accepting new patients
County of Monterey Past Accepting new patients

Locations

1801 Salmon Creek Ln
Juneau, AK 99801
Phone (907) 586-2434

20200 54th Ave W
Lynnwood, WA 98036
Phone (425) 672-6400

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: ejacobs26479@ghc.direct-ci.net

Organizations & group practices 6

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 37

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1831246966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20200 54TH AVE W",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366318",
            "telephone_number": "425-672-6518",
            "fax_number": "425-672-6518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20200 54TH AVE W",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366318",
            "telephone_number": "425-672-6518",
            "fax_number": "425-672-6518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1441 Constitution Blvd",
            "address_2": "BUILDING 500",
            "address_purpose": "LOCATION",
            "city": "Salinas",
            "state": "CA",
            "postal_code": "939063100",
            "country_code": "US",
            "telephone_number": "831-755-4373",
            "fax_number": "831-751-0204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "ELISABETH",
        "middle_name": "DORAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A75610",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60117921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A756100",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "20200 54th Ave W",
            "city": "Lynnwood",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980366318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

Verify at the official NPI Registry.