Jacob C. Brown, PA-C
Individual provider Active NPI Physician Assistant · Del City, OK
NPI 1972035145 · NPPES record last updated Mar 28, 2017
Key facts
- NPI
- 1972035145
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA2738 (OK)
- Practice address
- 5300 SE 29TH St
Del City, OK 73115-4702 - Phone
- (405) 835-2770
- NPI assigned
- Mar 28, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 23
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Psychplus
Practice addresses (Care Compare)
4220 N Classen Blvd
Suite F
Oklahoma City, OK 73118-2416
Phone (405) 259-2333
Hospital & facility affiliations
- Mercy Hospital Ada
- Mercy Hospital Healdton, Inc.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170503001062 | OK | Practitioner - Physician Assistant | 1355628108 | Reassigns benefits to 14 organizations |
| I20250731003000 | TX | Practitioner - Physician Assistant | 1355628108 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2738 | OK | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ies ER Oklahoma LLC | Current |
Accepting new patients | |
| Mercy Hospital Tishomingo, Inc. | Current |
Accepting new patients | |
| Board of Regents of the University of Oklahoma - Ou Physicians | Current |
Accepting new patients | |
| Ou Health Partners, Inc | Current |
Accepting new patients | |
| Mercy Hospital Kingfisher, Inc | Current |
Accepting new patients | |
| Board of Regents of the University of Oklahoma - Ou Physicians | Current |
Accepting new patients | |
| Mercy Hospital Tishomingo, Inc | Current |
Accepting new patients | |
| Mercy Hospital Healdton, Inc. | Current |
Accepting new patients | |
| Mercy Hospital Tishomingo, Inc. | Current |
Accepting new patients | |
| Mercy Hospital Watonga Inc | Current |
Accepting new patients | |
| Mercy Hospital Logan County, Inc | Current |
Accepting new patients | |
| Creek Nation Hospital & Clinics | Current |
Accepting new patients | |
| Oca MWC LP | Past | Accepting new patients | |
| Mercy Hospital Ardmore, Inc. | Past | Accepting new patients |
Locations
200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165
3462 Hospital Rd
Healdton, OK 73438
Phone (580) 229-0701
1000 Hospital Dr
Kingfisher, OK 73750
Phone (405) 375-3141
825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864
700 NE 13th St
Oklahoma City, OK 73104
Phone (405) 271-3667
900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230
1000 S Byrd St
Tishomingo, OK 73460
Phone (580) 371-2327
10501 E 91st St
Tulsa, OK 74133
Phone (918) 307-6000
Dept 1467
Tulsa, OK 74182
6161 S Yale Ave
Tulsa, OK 74136
Phone (918) 494-2200
10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760
500 N Clarence Nash Blvd
Watonga, OK 73772
Phone (580) 623-2233
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2738 | OK | Yes |
Addresses
Primary practice location
5300 SE 29TH St
Del City, OK 73115-4702
Mailing address
5200 SE 51St St
Oklahoma City, OK 73135-4202
Phone (479) 966-0882
Other providers in Del City, OK
- Matthew J Boeckman
- Breanna Eviemarie Boor
- Mackenzie Alexis Boyle
- Shane Palmer Braig
- Melanie Elaine Broadway
- Trendolyn Brown
- Carl Bryant
- Carmen Delores Butler
- Brooklyn Byrd
- Alexis Caldwell
All providers in Del City, OK · Physician Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.