Active NPI
Trevor H Jacob, MD
- Internal Medicine Physician
- Lafayette, CO
National Provider Identifier
1891826699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 42073
- Practice address
- 200 Exempla Cir
Lafayette, CO 80026-3370 - Phone
- (303) 338-4545
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 42073 | CO | Primary |
Addresses
Primary practice location
200 Exempla Cir
Lafayette, CO 80026-3370
Mailing address
10350 E Dakota Ave
Denver, CO 80247-1314
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26107031 | Medicaid | CO | |
| 016374 | Other | KAISER-COMMERCIAL NUMBER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways | Health Information Exchange (HIE) |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42073 | CO | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623715200000",
"number": "1891826699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10350 E DAKOTA AVE",
"city": "DENVER",
"state": "CO",
"postal_code": "802471314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 EXEMPLA CIR",
"city": "LAFAYETTE",
"state": "CO",
"postal_code": "800263370",
"telephone_number": "303-338-4545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "TREVOR",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-07",
"last_updated": "2021-06-15",
"certification_date": "2021-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CO",
"license": "42073",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "26107031",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER-COMMERCIAL NUMBER",
"identifier": "016374",
"state": null
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways",
"affiliation": "N",
"endpointDescription": "Carequality",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "200 Exempla Cir",
"city": "Lafayette",
"state": "CO",
"country_code": "US",
"postal_code": "800263370",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lafayette, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.