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DR. JACOB STAFFORD EDMISSON MD
NPI 1609444967
Student in an Organized Health Care Education/Training Program in Indianapolis, IN

Active since June 14, 2021PECOS Enrolled
535 BARNHILL DR, INDIANAPOLIS, IN 46202(317) 948-6942 Get Directions Write a Review

NPPES record last updated: June 18, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 18, 2024, Jun 14, 2021 (2 updates tracked since 2021).

About Dr. Jacob Stafford Edmisson Md NPPES

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

DR. JACOB STAFFORD EDMISSON MD (NPI 1609444967) is an individual student in an organized health care education/training program in Indianapolis, Indiana, licensed in Indiana (11023782A) and active in the NPI registry since June 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1609444967
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. JACOB STAFFORD EDMISSONCredential: MD
Location Address535 BARNHILL DRIndianapolis, IN 46202-5116
Mailing Address535 Barnhill DrIndianapolis, IN 46202-5116 · (317) 948-6942
Phone(317) 948-6942
Sole ProprietorNo
Enumeration DateJune 14, 2021
Last NPPES UpdateJune 18, 20242 updates tracked since enumeration
NPPES CertifiedJune 18, 2024
✔ NPI 1609444967 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in IN · 11023782A
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.
Also ListedInternal MedicineTaxonomy 207R00000X · License 2021021803 (MO)
535 BARNHILL DR, Indianapolis, IN 46202
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jacob Stafford Edmisson 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.

Other Providers at the Same Location NPPES 20

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

DR. ANTON ALEXI CABELLON D.O.
Internal Medicine (Nephrology)
535 BARNHILL DR, RT 150
INDIANAPOLIS, IN 46202
Marion County (317) 948-0728
LINDA BATTIATO
Registered Nurse
535 BARNHILL DR
INDIANAPOLIS, IN 46202
Marion County (317) 278-6489
CHRISTIAN JON NELSON PHD
Psychologist (Clinical)
535 BARNHILL DR
INDIANAPOLIS, IN 46202
Marion County (317) 948-2538
AMANJOT SINGH SETHI M.D.
Specialist
535 BARNHILL DR, SUITE 420
INDIANAPOLIS, IN 46202
Marion County (317) 278-1979
DR. ANITA AHMED TURK M.D.
Internal Medicine (Hematology & Oncology)
535 BARNHILL DR
INDIANAPOLIS, IN 46202
Marion County (317) 274-0335
JENNIFER MARIE KING MD
Internal Medicine (Hematology & Oncology)
535 BARNHILL DR
INDIANAPOLIS, IN 46202
Marion County (317) 944-0920
NANCY CAROL ISSA MD
Internal Medicine (Hematology & Oncology)
535 BARNHILL DR
INDIANAPOLIS, IN 46202
Marion County (317) 948-6942
BETH A KIRSCH RDN, CSO, LD
Dietitian, Registered (Nutrition, Oncology)
535 BARNHILL DR
INDIANAPOLIS, IN 46202
Marion County (317) 440-6242

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 Edmisson's NPI number?

The NPI number for Jacob Edmisson is 1609444967. It was assigned to this individual provider in the NPPES registry on June 14, 2021.

Where is Jacob Edmisson located?

Jacob Edmisson practices at 535 Barnhill Dr, Indianapolis, IN 46202. The listed phone number is (317) 948-6942.

What is Jacob Edmisson's specialty?

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

Is Jacob Edmisson enrolled in Medicare?

Yes. Jacob Edmisson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacob Edmisson was last updated on June 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.