JACOB EDWARD VAUGHN MD
NPI 1306475066
Student in an Organized Health Care Education/Training Program in Syracuse, NY

Q: What is Jacob Vaughn's NPI number?

The NPI number for Jacob Vaughn is 1306475066. It was assigned to this individual provider in the NPPES registry on April 5, 2020.

Q: What is Jacob Vaughn's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Jacob Vaughn was last updated on April 5, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 05, 2020PECOS Enrolled

750 E ADAMS ST, SYRACUSE, NY 13210(315) 464-1800 Get Directions Write a Review

NPPES record last updated: April 5, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Jacob Edward Vaughn Md NPPES

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

JACOB EDWARD VAUGHN MD (NPI 1306475066) is an individual student in an organized health care education/training program in Syracuse, New York and active in the NPI registry since April 2020. He is enrolled in Medicare PECOS and maintains a secondary practice location in Syracuse.

NPPES Registry Identity

NPI1306475066

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameJACOB EDWARD VAUGHNCredential: MD

Location Address750 E ADAMS STSyracuse, NY 13210-2306

Mailing Address1622 River RdMaumee, OH 43537-3508

Phone(315) 464-1800

Sole ProprietorYes

Enumeration DateApril 5, 2020

NPPES CertifiedApril 5, 2020

✔ NPI 1306475066 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

750 E ADAMS ST, Syracuse, NY 13210

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Secondary Practice Location 1

Location 1550 Harrison StSyracuse, NY 13202-3188 · Phone (315) 464-1800

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacob Edward Vaughn Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.