Jacob Lane

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

089244 Issued in IA

Practice address

411 Laurel St Ste 3250
Des Moines, IA 50314-3026

Phone

(515) 643-6400

Fax

(515) 643-5816

NPI assigned

Nov 28, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Kossuth Regional Health Center

  • Critical Access Hospital
  • Algona, IA
  • NPI 1841361276

  IA

  Medicare reassignment NPD
• Montgomery County Memorial Hospital

  • Internal Medicine Physician
  • Red Oak, IA
  • NPI 1265405310

  IA, Physician Assistant

  Medicare reassignment NPD
• Montgomery County Memorial Hospital

  • Critical Access Hospital
  • Red Oak, IA
  • NPI 1376539338

  IA

  Medicare reassignment NPD
• Trinity Regional Medical Center

  • Emergency Medicine Physician
  • Fort Dodge, IA
  • NPI 1073594156

  IA

  Medicare reassignment NPD
• Kossuth Regional Health Center

  • Family Medicine Physician
  • Algona, IA
  • NPI 1184636557

  IA

  Medicare reassignment
• Mercy Clinics, Inc.

  • Primary Care Clinic/Center
  • Clive, IA
  • NPI 1487670923

  IA

  Medicare reassignment
• Kossuth Regional Health Center

  • Critical Access Hospital
  • Algona, IA
  • NPI 1679644330
  NPD
• Mercy Clinics, Inc

  • Surgery Physician
  • Des Moines, IA
  • NPI 1063752459
  NPD
• Mercy Clinics, Inc.

  • Obstetrics & Gynecology Physician
  • Des Moines, IA
  • NPI 1508741505
  NPD
• Montgomery County Memorial Hospital

  • Community/Retail Pharmacy
  • Red Oak, IA
  • NPI 1699887547
  NPD
• Floyd County Memorial Hospital Commission

  • Critical Access Hospital
  • Charles City, IA
  • NPI 1265402390
  NPD (past)

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1992248744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-643-6400",
            "fax_number": "515-643-5816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 LAUREL ST STE 3250",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503143026",
            "telephone_number": "515-643-6400",
            "fax_number": "515-643-5816"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2945 S Dobson Rd",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852027941",
            "country_code": "US",
            "telephone_number": "480-969-4138 x171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2945 S Dobson Rd",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852027941",
            "country_code": "US",
            "telephone_number": "480-969-4138 x171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANE",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-28",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "860285905",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IA",
            "license": "089244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Drey Landgraf
• Jennifer Landgrebe, ARNP
• Rachel Griffin Landgrebe, AGACNP-BC
• Nicholas Ryan Landry, MS, PT, DPT
• Julia Landucci, PSY.D., L.P.
• Janice Beth Lane, LMSW
• Sharon Lane, OTR/L
• Allen Lang, MD
• Greta Jean Lange, RD
• Christine R Langel, NP

• All providers in Des Moines, IA
• Surgical Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.