JACOB SHANE TEBBS (PA-C) – Medical Physician Assistant, NPI 1154870251
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,534 PHYSICIAN ASSISTANT in ID
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Provider Addresses for JACOB SHANE TEBBS (PA-C)
6051, North Eagle Road, Boise, Ada County, Idaho, 83713, United States
BOISE, ID 837130997
Phone: (208) 519-4333
Fax: (208) 205-9134
Type: Location
999 N Curtis Rd Ste 307
Boise, ID 837061333
Phone: (208) 519-4333
Fax: (208) 205-9134
Type: Location
1900, North State Street, Carterville, Provo, Utah County, Utah, 84604, United States
PROVO, UT 846041305
Phone: (801) 373-2001
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 62 Open Payments records for all available years, with a total value of $1,159.
Total Amount is formed as General ($1,159) + Research ($0) + Ownership ($0) = $1,159.
Last reported payment date: 2024-12-19 • Largest payer in this snapshot: ABBVIE INC. ($353).
Total Amount
$1,159
General + Research + Ownership
Payments
62
Total payment records
General Amount
$1,159
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-19
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-07-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20200813001499 | I | Physician Assistant | ID | TBD |
| I20240724004624 | I | Physician Assistant | WY | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 441 | 80 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 151 | 125 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 144 | 112 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 100 | 76 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 98 | 84 | $0 |
Insurance plans in this area (ZIP 83713)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| D E R M A T O L O G Y | ID | |
| Physician Assistant | ID | |
| D E R M A T O L O G Y | MI | |
| D E R M A T O L O G Y | ID | |
| Physician Assistant | ID | |
| Physician Assistant | ID |
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