CHARLES A JACOBSON (NPI# 1760492656) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760492656 |
| Entity Type | Individual |
| Full Name | CHARLES A JACOBSON |
| Credential | M.D. |
| Practice Address |
2500 W A St Suite 201 Moscow ID 83843-5065 |
| Practice Telephone | 2088832828 |
| Practice Fax Number | 2088822179 |
| Mailing Telephone | 2088832828 |
| Mailing Fax Number | 2088822179 |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2015-08-04 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 31851 | WA | Allopathic & Osteopathic Physicians |
| Y | 207X00000X | Orthopaedic Surgery | M6567 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 002743901 | 05 | |
| WA | 1092733 | 05 | |
| WA | DEPT OF LABOR | 0102784 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124092754 | Charles D Jacobson | Internal Medicine | 1701 3rd St Se, Puyallup, WA 98372-4511 | 2006-02-13 |
| Street Address |
2500 W A ST SUITE 201 |
| City | MOSCOW |
| State | ID |
| Zip Code | 83843-5065 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013359546 | Julia W Cheng | Audiologist | 2500 W A St, Suite 202, Moscow, ID 83843-6000 | 2013-07-25 |
| 1245518000 | Michelle Lynn Gorton | Specialist/Technologist, Other | 2500 W A St, Suite 201, Moscow, ID 83843-6000 | 2011-07-28 |
| 1558503581 | Sheri Danielle Erwin | Nurse Practitioner | 2500 W A St, Moscow, ID 83843-6000 | 2009-04-06 |
| 1720227010 | Katherine Michele Baughman Gleason | Optometrist | 2500 W A St, Suite 202, Moscow, ID 83843-6000 | 2009-02-11 |
| 1598929796 | Shawn Charles Richards | Ophthalmology | 2500 W A St, Suite 202, Moscow, ID 83843-6000 | 2008-07-16 |
| 1144376617 | Charles A Jacobson Md | Orthopaedic Surgery | 2500 W A St, Suite 201, Moscow, ID 83843-6000 | 2007-01-26 |
| 1043379944 | David Bryan Leach | Ophthalmology | 2500 W A St, Suite 202, Moscow, ID 83843-6000 | 2006-12-06 |
| 1407915325 | Clearview Eye Clinic Ltd | Optometrist | 2500 W A St, Suite 202, Moscow, ID 83843-6000 | 2006-12-06 |
| 1407921950 | Monty J Boydston | Specialist/Technologist, Other | 2500 W A St, Suite 201, Moscow, ID 83843-6000 | 2006-11-21 |
| 1740290642 | Steven E Pennington | Orthopaedic Surgery | 2500 W A St, Suite 201, Moscow, ID 83843-5065 | 2006-08-09 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033726880 | Moscow Physical Therapy, LLC | Clinic/Center | 1174 Alturas Drive, Suite 2, Moscow, ID 83843 | 2020-09-25 |
| 1831703057 | Hydee Flishaw Tubbs Becker | Dietitian, Registered | 614 North Hayes Street, Moscow, ID 83843 | 2020-09-04 |
| 1528626959 | Ryan Steven Clark | Student in an Organized Health Care Education/Training Program | 212 Farm Road, #201, Moscow, ID 83843 | 2019-05-31 |
| 1770141384 | Lingwen Zhang | Specialist/Technologist | 901 Paradise Creek Rd, Moscow, ID 83843 | 2019-05-30 |
| 1306363478 | Elizabeth Campbell | Dietitian, Registered | 611 S. Main, Moscow, ID 83843 | 2017-08-29 |
| 1598285496 | Gina Cretser | Counselor | 212 Rodeo Dr. #410, Moscow, ID 83843 | 2017-06-21 |
| 1124558721 | Morgan Leigh Derloshon | Specialist/Technologist | 275 Southview Ave, Apt 206, Moscow, ID 83843 | 2017-06-15 |
| 1619411790 | Kaylene Howard | Massage Therapist | 127 South Washington, Suite 6, Moscow, ID 83843 | 2016-12-08 |
| 1407237043 | Jacob Kent Christensen | Family Medicine | 831 S Ash St, Moscow, ID 83843 | 2015-06-09 |
| 1366851388 | Elisabeth Henry | Pharmacist | 2740 West Pullman Rd, Moscow, ID 83843 | 2014-08-04 |
| Find all providers in zip 83843 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851549901 | Kyle J Hazelwood | Orthopaedic Surgery | 2500 W A St Ste 201, Moscow, ID 83843-6000 | 2008-09-03 |
| 1952877763 | Inland Orthopaedic Surgery and Sports Medicine Clinic Pllc | Orthopaedic Surgery | 2500 W A St Ste 201, Moscow, ID 83843-6000 | 2018-10-18 |
| 1144376617 | Charles A Jacobson Md | Orthopaedic Surgery | 2500 W A St, Suite 201, Moscow, ID 83843-6000 | 2007-01-26 |
| 1740290642 | Steven E Pennington | Orthopaedic Surgery | 2500 W A St, Suite 201, Moscow, ID 83843-5065 | 2006-08-09 |
| 1285644195 | Edwin M Tingstad | Orthopaedic Surgery | 2500 W A St, Suite 201, Moscow, ID 83843-6000 | 2006-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770101594 | Brittney Davis | Orthopaedic Surgery | 5910 W Targee St, Boise, ID 83709-3151 | 2020-07-08 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1942668157 | Allied Orthopaedics, LLC | Orthopaedic Surgery | 1789 S Broadway Ave, Suite 100, Boise, ID 83706-3800 | 2016-02-02 |
| 1053779264 | Allied Orthopaedics, LLC | Orthopaedic Surgery | 16818 N Marketplace Blvd, Nampa, ID 83687-5140 | 2016-02-02 |
| 1841611027 | Christopher Frederic Jessen | Orthopaedic Surgery | 5475 E Shoreline Dr, Post Falls, ID 83854-6858 | 2013-12-14 |
| 1881934404 | Kym Orthopedics Pllc | Orthopaedic Surgery | 3316 4th St #4b, Lewiston, ID 83501-4405 | 2013-02-19 |
| 1891056826 | Jonathan Klaucke | Orthopaedic Surgery | 606 N Third Ave Ste 201, Sandpoint, ID 83864 | 2012-06-06 |
| 1508168139 | Lyman Orthopedics Pllc | Orthopaedic Surgery | 1875 N Lakewood Dr, Suite 200, Coeur D Alene, ID 83814-4928 | 2010-12-02 |
| 1639495708 | Krysten Marie Bell | Orthopaedic Surgery | 2178 S Myers Pl, Boise, ID 83706-5503 | 2010-04-14 |
| 1700114725 | David Louis Schenkar | Orthopaedic Surgery | 110 E Gulch Rd, Hailey, ID 83333-8496 | 2009-12-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.