NPIMap

Individual provider Active NPI

Brian Jay Jacobson, PA-C

  • Physician Assistant
  • Palm Desert, CA
National Provider Identifier
1851877930
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
57284 Issued in CA
Practice address
72650 Fred Waring Dr Ste 204
Palm Desert, CA 92260-5009
Phone
(760) 760-3434
Fax
(760) 760-4345
NPI assigned
Jul 12, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 8350108-1206 UT
Physician Assistant 363A00000X 57284 CA Primary

Addresses

Primary practice location

72650 Fred Waring Dr Ste 204
Palm Desert, CA 92260-5009

Mailing address

72650 Fred Waring Dr Ste 204
Palm Desert, CA 92260-5009
Phone (760) 760-3434

Other practice location 1

1221 N Indian Canyon Dr
Palm Springs, CA 92262-4875
Phone (760) 610-8650 ext. 308

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8350108-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
La Laser Center PC, a Professional Medical Corporation PastSince Jan 28, 2024 Accepting new patients
La Laser Center PC, a Professional Medical Corporation PastSince Feb 1, 2020 Accepting new patients
La Laser Center PC a Professional Medical Corporation PastSince Feb 18, 2024 Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1851877930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72650 FRED WARING DR STE 204",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922605009",
            "telephone_number": "760-760-3434",
            "fax_number": "760-760-4345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72650 FRED WARING DR STE 204",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922605009",
            "telephone_number": "760-760-3434",
            "fax_number": "760-760-4345"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1221 N Indian Canyon Dr",
            "address_purpose": "LOCATION",
            "city": "Palm Springs",
            "state": "CA",
            "postal_code": "922624875",
            "country_code": "US",
            "telephone_number": "760-610-8650 x308",
            "fax_number": "760-760-4345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "BRIAN",
        "middle_name": "JAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-12",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "8350108-1206",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "57284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Desert, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.