Autum Renee Jacobs, FNP-BC is a medicare enrolled "Nurse Practitioner - Family" physician in Prescott Valley, Arizona. Her current practice location is
6648 N Viewpoint Dr Ste 5, Prescott Valley, Arizona. You can reach out to her office (for appointments etc.) via phone at
(928) 708-4800.
Autum Renee Jacobs is licensed to practice in Arizona (license number 314886) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1235954926.
Physician's Profile
| Full Name | Autum Renee Jacobs |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 6648 N Viewpoint Dr Ste 5, Prescott Valley, Arizona |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1235954926
- Provider Enumeration Date: 11/19/2024
- Last Update Date: 11/25/2024
Medicare PECOS Information:
- PECOS PAC ID: 8820524531
- Enrollment ID: I20241204004098
Medical Identifiers
Medical identifiers for Autum Renee Jacobs such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1235954926 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207RG0100X | Internal Medicine - Gastroenterology | 314886 (Arizona) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 314886 (Arizona) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Autum Renee Jacobs allows following entities to bill medicare on her behalf.
| Entity Name | Yavapai Regional Medical Center Physician Care, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1255582003
PECOS PAC ID: 5294898987
Enrollment ID: O20090106000798 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Autum Renee Jacobs is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Autum Renee Jacobs, FNP-BC
Po Box 10880,
Prescott, AZ 86304-0880
Ph: (602) 406-4786 | Autum Renee Jacobs, FNP-BC
6648 N Viewpoint Dr Ste 5,
Prescott Valley, AZ 86315-4942
Ph: (928) 708-4800 |
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