Jacob Connor Lansberry, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

0010-13502 Issued in NC

Practice address

3009 New Bern Ave
Raleigh, NC 27610-1214

Phone

(919) 232-5020

NPI assigned

Jun 12, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wakemed, Cary Hospital Hospital, Cary, NC, CCN 340173
• Wakemed, Raleigh Campus Hospital, Raleigh, NC, CCN 340069

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jlansberry483813@directhisp.wakemed.org

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.

• Wakemed Specialists Group, LLC

  • Cardiovascular Disease Physician
  • Raleigh, NC
  • NPI 1588227839
  Medicare reassignment Care Compare group
• Wakemed Specialists Group LLC

  dba WakeMed - Virtual Cardiac Rehab

  • Cardiac Rehabilitation Registered Nurse
  • Raleigh, NC
  • NPI 1063304228
  NPD
• Wakemed Specialists Group, LLC

  • Pediatric Cardiology Physician
  • Raleigh, NC
  • NPI 1013571405
  NPD

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

• Wakemed

  dba Wakemed Cary Hospital

  • General Acute Care Hospital
  • Cary, NC
  • NPI 1114993086
  Care Compare affiliation
• Wakemed

  dba WakeMed Mental Health & Well-Being Hospital WakeBrook

  • Psychiatric Hospital Unit
  • Raleigh, NC
  • NPI 1780446302
  Care Compare affiliation
• Wakemed

  dba WakeMed Raleigh Campus

  • General Acute Care Hospital
  • Raleigh, NC
  • NPI 1972579837
  Care Compare affiliation

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

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1912681867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603949",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603949",
            "telephone_number": "919-350-0351",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101214",
            "telephone_number": "919-232-5020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANSBERRY",
        "first_name": "JACOB",
        "middle_name": "CONNOR",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-13502",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "0010-13502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912681867",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Micha Sytoria Kris Lanier, PA-C
• Gerald W Lankford Jr., MBA, MACC, MDIV, LPC
• Molly Elizabeth Lankford, LCMHCA
• Ethan Lanphere
• Jacklyn Lansana
• Elizabeth F Lansing, MSW
• Jeanne G Lansing, CCC-A
• Cathy Jo Lanter, RPH
• Lantern Professional Nursing Agency, P.a.
• Christine Lea Lapaire, LCSWA

• Surgical Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Surgical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.