JACOB PAUL BOEHME PAC
Complete NPI Record 1215501127
Physician Assistant in Greencastle, PA
Active since May 14, 2021PECOS EnrolledAccepts Medicare Assignment
78.53/100
CMS Quality Rating
Complete NPI Dataset
This page contains the complete raw NPPES record for Jacob Paul Boehme, PAC (NPI 1215501127), an individual physician assistant provider in Greencastle, PA. All 30 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1215501127 Field 1/30
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/30
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: BOEHME Field 3/30
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: JACOB Field 4/30
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: PAUL Field 5/30
- The middle name of the provider, if the provider is an individual.
- Provider Credential Text: PAC Field 6/30
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider First Line Business Mailing Address: 601 MEMORY LN Field 7/30
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: YORK Field 8/30
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: PA Field 9/30
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 174022231 Field 10/30
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/30
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 7178511405 Field 12/30
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 7178516969 Field 13/30
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 24 ANTRIM COMMONS DR Field 14/30
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: GREENCASTLE Field 15/30
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: PA Field 16/30
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 172251623 Field 17/30
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/30
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 7175930512 Field 19/30
- The telephone number associated with the location address of the provider being identified.
- Provider Gender Code: M Field 22/30
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 363A00000X Field 23/30
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: MA062648 Field 24/30
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: PA Field 25/30
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 26/30
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 390200000X Field 27/30
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 28/30
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: N Field 29/30
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
Secondary Practice Locations 14
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
101 W Airport Rd
Location 1/14Lititz, PA 17543-9274 · Phone (717) 466-2445 · Fax (717) 466-2447
601 E Main St
Location 2/14Waynesboro, PA 17268-2332 · Phone (717) 765-5088 · Fax (717) 857-2515
24 Antrim Commons Dr
Location 3/14Greencastle, PA 17225-1623 · Phone (717) 593-0512 · Fax (717) 839-6810
227 Hospital Dr Ste 1
Location 4/14Everett, PA 15537-7019 · Phone (717) 860-1362
100 Eisenhower Dr Ste 360
Location 5/14Hanover, PA 17331-5241 · Phone (717) 646-4201
455 S Washington St Ste 12
Location 6/14Gettysburg, PA 17325-2516 · Phone (717) 339-2875 · Fax (717) 334-3921
1000 Norland Ave
Location 7/14Chambersburg, PA 17201-4229 · Phone (717) 267-6363
4050 N George Street Ext
Location 8/14Manchester, PA 17345-9347 · Phone (717) 356-4370 · Fax (717) 260-3316
2149 S Queen St
Location 9/14York, PA 17403-4845 · Phone (717) 356-4460 · Fax (717) 260-3326
717 Town Center Drive
Location 10/14York, PA 17408-4824 · Phone (717) 356-4240
446 N Reading Rd
Location 11/14Ephrata, PA 17522-9802 · Phone (717) 738-5275
9 Nathan Ln
Location 12/14Annville, PA 17003-6500 · Phone (717) 639-3350
96 Sofia Dr Ste 208
Location 13/14Shrewsbury, PA 17361-5201 · Phone (717) 812-2400 · Fax (717) 812-3005
46 Walnut Bottom Rd Ste 100
Location 14/14Shippensburg, PA 17257-8219 · Phone (717) 477-2764 · Fax (717) 839-6951
No registry entries match your active lookup criteria.
