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MR. JACOB WAYNE MOSS M.D., J.D.
NPI 1205179751
General Practice in Saint Anthony, ID

Active since April 03, 2013PECOS EnrolledAccepts Medicare Assignment
335 E MAIN ST STE 1, SAINT ANTHONY, ID 83445(208) 356-4900(208) 624-4116 Get Directions Write a Review

NPPES record last updated: October 15, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 22, 2022, Feb 17, 2020, Mar 14, 2019 (3 updates tracked since 2019).

About Mr. Jacob Wayne Moss M.d., J.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JACOB WAYNE MOSS M.D., J.D. (NPI 1205179751) is an individual general practice provider in Saint Anthony, Idaho, licensed in Idaho (M-14547) and active in the NPI registry since April 2013. He is enrolled in Medicare PECOS, is affiliated with Madison Memorial Hospital, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1205179751
Entity TypeIndividualMale
Primary Taxonomy208D00000X
Provider Legal NameMR. JACOB WAYNE MOSSCredential: M.D., J.D.
Location Address335 E MAIN ST STE 1Saint Anthony, ID 83445-1546
Mailing AddressPo Box 18Saint Anthony, ID 83445-0018 · (208) 356-4900 · Fax (208) 624-4112
Phone(208) 356-4900
Fax(208) 624-4116
Sole ProprietorNo
Medical School CMSSouthern Illinois University School Of MedicineGraduated 2013
Enumeration DateApril 3, 2013
Last NPPES UpdateOctober 15, 20253 updates tracked since enumeration
NPPES CertifiedOctober 15, 2025
✔ NPI 1205179751 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Licenses✔ Licensed in ID · M-14547✔ Licensed in GA · TM190
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
335 E MAIN ST STE 1, Saint Anthony, ID 83445
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Secondary Practice Locations 2

Location 13724 Woodking Dr Ste 1Idaho Falls, ID 83404 · Phone (208) 356-4900 · Fax (208) 612-6118
Location 272 S 1st E Ste 101Rexburg, ID 83440-1902 · Phone (208) 356-4900 · Fax (208) 356-3724

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Jacob Wayne Moss M.d., J.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID42454159
PECOS Enrollment IDI20191231002364
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Madison Memorial Hospital

Acute Care Hospitals · Rexburg, ID
5/5 CMS rating
OwnershipGovernment - Local
CMS Certification Number130025
Location450 East Main StreetRexburg, ID 83440 · Madison County
Emergency services

Teton Valley Hospital

Critical Access Hospitals · Driggs, ID
OwnershipVoluntary non-profit - Private
CMS Certification Number131313
Location120 East Howard AveDriggs, ID 83422 · Teton County
Emergency services

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MINDY JENSEN LCSW
Social Worker (Clinical)
335 E MAIN ST STE 1
SAINT ANTHONY, ID 83445
Fremont County (208) 356-4900
AMBERLY GUYMON LMSW
Social Worker
335 E MAIN ST STE 1
SAINT ANTHONY, ID 83445
Fremont County (208) 356-4900
WHITTNEY KAY MILLER FNP-C
Nurse Practitioner (Family)
335 E MAIN ST STE 1
SAINT ANTHONY, ID 83445
Fremont County (208) 356-4900
DR. TREVOR GLADE WILDE D.O.
Family Medicine
335 E MAIN ST STE 1
SAINT ANTHONY, ID 83445
Fremont County (208) 356-4900
RYAN G WILLMORE PA-C
Physician Assistant
335 E MAIN ST STE 1
SAINT ANTHONY, ID 83445
Fremont County (208) 356-4900
ANDREW LOGAN BROWER PA-C
Physician Assistant
335 E MAIN ST STE 1
SAINT ANTHONY, ID 83445
Fremont County (208) 356-4900
BRYCE DAVID WYLIE PA-C
Physician Assistant
335 E MAIN ST STE 1
SAINT ANTHONY, ID 83445
Fremont County (208) 356-4900
LARRY MILES BRADLEY LCSW
Social Worker (Clinical)
335 E MAIN ST STE 1
SAINT ANTHONY, ID 83445
Fremont County (208) 356-4900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Moss's NPI number?

The NPI number for Jacob Moss is 1205179751. It was assigned to this individual provider in the NPPES registry on April 3, 2013.

Where is Jacob Moss located?

Jacob Moss practices at 335 E Main St Ste 1, Saint Anthony, ID 83445. The listed phone number is (208) 356-4900.

What is Jacob Moss's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Jacob Moss enrolled in Medicare?

Yes. Jacob Moss is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Jacob Moss affiliated with any hospitals?

According to CMS data, Jacob Moss is affiliated with Madison Memorial Hospital and Teton Valley Hospital.

When was this NPI record last updated?

The NPPES record for Jacob Moss was last updated on October 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.