NPIMap

Individual provider Active NPI

Jacob Bryce Thatcher, DO

  • Urology Physician
  • Stratford, NJ
National Provider Identifier
1992263438
Registry record updated Mar 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MSO0262 Issued in ID
Practice address
1 Medical Center Dr Ste 162
Stratford, NJ 08084-1500
Phone
(856) 566-6946
NPI assigned
Mar 4, 2019
Last updated
Mar 4, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MSO0262 ID Primary

Addresses

Primary practice location

1 Medical Center Dr Ste 162
Stratford, NJ 08084-1500

Mailing address

1 Medical Center Dr Ste 162
Stratford, NJ 08084-1500
Phone (856) 566-6946

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240531002279 ID Practitioner - Urology 2264874528 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 557-2700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection32

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
MSO0262IDMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Urology 1 PLLC Urology Current Accepting new patients
Mountain View Hospital LLC CurrentSince Jul 1, 2024 Accepting new patients
Mountain View Hospital Physician Organization Past Accepting new patients

Locations

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

2375 Coronado St
Idaho Falls, ID 83404
Phone (208) 522-4600

380 Walker Dr
Rexburg, ID 83440
Phone (208) 356-9559

404 N 2nd E
Rexburg, ID 83440
Phone (208) 359-1770

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1551657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551657600000",
    "number": "1992263438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR STE 162",
            "city": "STRATFORD",
            "state": "NJ",
            "postal_code": "080841500",
            "telephone_number": "856-566-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR STE 162",
            "city": "STRATFORD",
            "state": "NJ",
            "postal_code": "080841500",
            "telephone_number": "856-566-6946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THATCHER",
        "first_name": "JACOB",
        "middle_name": "BRYCE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-04",
        "last_updated": "2019-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ID",
            "license": "MSO0262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stratford, NJ

Sources for this page

Verify at the official NPI Registry.