Jacob Tanner Kobernick, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11158 Issued in AZ

Practice address

14520 W Granite Valley Dr Ste 210
Sun City West, AZ 85375-5855

Phone

(866) 974-2673

Fax

(866) 939-2673

NPI assigned

May 27, 2025

Sex

Male

Sole proprietor

No

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

Enrolled in AZ

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, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Center for Orthopedic Research and Education LLCGroup PAC ID 0345287322, 247 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner del E. Webb Medical Center Hospital, Sun City West, AZ, CCN 030093
• The Core Institute Specialty Hosp Hospital, Phoenix, AZ, CCN 030108
• Wickenburg Community Hospital Hospital, Wickenburg, AZ, CCN 031300

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacob.kobernick.1@22724.direct.athenahealth.com

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.

• Center for Orthopedic Research and Education, LLC

  • Orthopaedic Surgery Physician
  • Phoenix, AZ
  • NPI 1427095801

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Northern Cochise Community Hospital Inc

  • Critical Access Hospital
  • Willcox, AZ
  • NPI 1013060367
  NPD (past)

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

• Banner del E Webb Medical Center

  • General Acute Care Hospital
  • Sun City West, AZ
  • NPI 1588823553
  Care Compare affiliation
• Community Hospital Association, Inc.

  • Critical Access Hospital
  • Wickenburg, AZ
  • NPI 1841282852
  Care Compare affiliation
• Surgical Specialty Hospital of Arizona, LLC

  • Special Hospital
  • Phoenix, AZ
  • NPI 1902881295
  Care Compare affiliation

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

{
    "created_epoch": "1748304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1942093695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18444 N 25TH AVE STE 310",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850231266",
            "telephone_number": "866-974-2673",
            "fax_number": "866-939-2673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14520 W GRANITE VALLEY DR STE 210",
            "city": "SUN CITY WEST",
            "state": "AZ",
            "postal_code": "853755855",
            "telephone_number": "866-974-2673",
            "fax_number": "866-939-2673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBERNICK",
        "first_name": "JACOB",
        "middle_name": "TANNER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-27",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "11158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylee Jo King, MA, BCBA, LBA
• Kingfisher Family Medicine, PLLC
• Borislav T Kirov, M.D.
• Barry Stephan Kirschner, DDS
• KLM Enterprise, PLLC
• Bonnie De Lane Koch, OTR/L
• Amoa Tamara Kolbeck, MS, BCBA, LBA
• Molly Rose Kommer, PA-C
• Michael V Koss, MD
• Alyssa Marie Kotzbauer, SLP-CCC

• Physician Assistant in Sun City West, AZ
• Providers in Sun City West, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; 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.