NPIMap

Individual provider Active NPI

Jakob Carlson, PA

  • Physician Assistant
  • Corvallis, OR
National Provider Identifier
1871300665
Registry record updated May 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA223663 Issued in OR
Practice address
3620 NW Samaritan Dr Ste 202
Corvallis, OR 97330-3785
Phone
(541) 768-4810
NPI assigned
Dec 16, 2024
Last updated
May 2, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2025

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 PA223663 OR Primary

Addresses

Primary practice location

3620 NW Samaritan Dr Ste 202
Corvallis, OR 97330-3785

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jcarlson321216@samhealth.direct-ci.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250407003055 OR Practitioner - Physician Assistant 6103340583 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Good Samaritan Hospital CorvallisGroup PAC ID 1557270725, 372 clinicians

Practice addresses (Care Compare)

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

3620 NW Samaritan Dr
Corvallis, OR 97330-3785

3620 NW Samaritan Dr
Corvallis, OR 97330-4714

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Corvallis CurrentSince Apr 7, 2025 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Apr 7, 2025 Accepting new patients

Locations

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

3620 NW Samaritan Dr
Ste 202
Corvallis, OR 97330
Phone (541) 768-4810

815 NW 9th St
Ste 215
Corvallis, OR 97330
Phone (541) 768-1888

Interoperability endpoints

  • Direct secure messaging: jcarlson321216@samhealth.direct-ci.com

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.

Hospital & facility affiliations 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746144000000",
    "number": "1871300665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1189",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 NW SAMARITAN DR STE 202",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303785",
            "telephone_number": "541-768-4810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "JAKOB",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-16",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA223663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcarlson321216@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "3620 NW Samaritan Dr Ste 202",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973303785",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.