Jacob Ediba

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

MCS-10-0005-0464R1 Issued in IL

Practice address

273 Keystone Dr Apt 5
Rantoul, IL 61866-2774

Phone

(217) 418-7384

NPI assigned

Jan 22, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Heavenly Hands Care Inc

  • In Home Supportive Care Agency
  • Indianapolis, IN
  • NPI 1306701735
  NPD Authorized official

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

{
    "created_epoch": "1453420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480464000000",
    "number": "1871950782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "273 KEYSTONE DR APT 5",
            "city": "RANTOUL",
            "state": "IL",
            "postal_code": "618662774",
            "telephone_number": "217-418-7384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "273 KEYSTONE DR APT 5",
            "city": "RANTOUL",
            "state": "IL",
            "postal_code": "618662774",
            "telephone_number": "217-418-7384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDIBA",
        "first_name": "JACOB",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-01-22",
        "last_updated": "2016-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "IL",
            "license": "MCS-10-0005-0464R1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristan Creel
• Alexa Crossman
• Cunningham Children'S Home of Urbana Il
• Michael De Venecia, PA-C
• Maureen Dickman, M.S. CCC-SLP
• Educational SVC Region Office
• Empowerme Rehabilitation Illinois, LLC
• Danielle Marie Faber, PHARMD
• Mark A. Faught, DDS
• Alexis Fiscus

• Non-emergency Medical Transport (VAN) in Rantoul, IL
• Providers in Rantoul, IL by specialty
• Non-emergency Medical Transport (VAN) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; 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.