Jacob Trudeau, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

950 E Bogard Rd Ste 103
Wasilla, AK 99654-7184

Phone

(907) 352-2883

Fax

(907) 352-2805

NPI assigned

Jan 24, 2017

Last updated

Dec 5, 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 1

Addresses

Electronic endpoints 2

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Tanana Valley Clinic LLCGroup PAC ID 5698056901, 142 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fairbanks Memorial Hospital Hospital, Fairbanks, AK, CCN 020012

Merit-based Incentive Payment System (MIPS)

Final score

92.86 of 100Reported as group

Quality

94.88

Promoting interoperability

100

Improvement activities

40

Cost

79.39

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacob.trudeau@direct.tananavalley.nextgenshare.com

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.

• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1922559558
  Medicare reassignment Care Compare group NPD
• Southeast Urgent Care Incorporated

  dba Juneau Urgent and Family Care

  • Family Medicine Physician
  • Juneau, AK
  • NPI 1841386117
  Medicare reassignment
• Mat Su Valley Medical Center LLC

  dba Mat-Su Regional Urgent Care

  • Urgent Care Clinic/Center
  • Wasilla, AK
  • NPI 1912950148
  NPD
• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1073081485
  NPD
• The Queen's Medical Center

  dba The Queen's Health Care Centers

  • Health Service Clinic/Center
  • Honolulu, HI
  • NPI 1609498682
  NPD
• The Queens Medical Center

  • General Acute Care Hospital
  • Honolulu, HI
  • NPI 1184612764
  NPD

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

• Fairbanks Memorial Hospital, LLC

  • General Acute Care Hospital
  • Fairbanks, AK
  • NPI 1720537178
  Care Compare affiliation

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

{
    "created_epoch": "1485216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1841737202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 JOSEPH CT",
            "city": "GIBSONIA",
            "state": "PA",
            "postal_code": "150448057",
            "telephone_number": "412-779-0519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 E BOGARD RD STE 103",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547184",
            "telephone_number": "907-352-2883",
            "fax_number": "907-352-2805"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "209 W Evergreen Ave",
            "address_purpose": "LOCATION",
            "city": "Palmer",
            "state": "AK",
            "postal_code": "996456952",
            "country_code": "US",
            "telephone_number": "907-861-1400",
            "fax_number": "907-861-1405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRUDEAU",
        "first_name": "JACOB",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-24",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacob.trudeau.2@2839.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "950 E Bogard Rd Ste 103",
            "city": "Wasilla",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996547184",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacob.trudeau.1@2839.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR Direct Address",
            "address_1": "209 W Evergreen Ave",
            "city": "Palmer",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996456952",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Medical Physician Assistant in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Medical Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.