MR. JACOB SMITH (PA-C, ATC) – Physician Assistant, NPI 1548675945
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Provider Addresses for MR. JACOB SMITH (PA-C, ATC)
1111 TRINITY LN STE 111
BLOOMINGTON, IL 617048112
Phone: (309) 663-6461
Type: Location
309 LAKE SHORE CIR
BLOOMINGTON, IL 617041412
Phone: (912) 515-6645
Type: Mailing
611 W. PARK ST.
FAPC
URBANA, IL 61801
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 9 Open Payments records for all available years, with a total value of $170.
Total Amount is formed as General ($170) + Research ($0) + Ownership ($0) = $170.
Last reported payment date: 2024-08-21 • Largest payer in this snapshot: Ferring Pharmaceuticals Inc. ($92).
Total Amount
$170
General + Research + Ownership
Payments
9
Total payment records
General Amount
$170
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-21
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Ferring Pharmaceuticals Inc. | $92 |
| Amgen Inc. | $43 |
| Orthofix Medical, Inc. | $18 |
| Bioventus LLC | $17 |
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: 2021-09-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20210930002333 | I | Physician Assistant | IL | 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 |
|---|---|---|---|---|
| J7318 | Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg | 1,200 | 12 | $0 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 258 | 24 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 96 | 87 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 80 | 49 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 71 | 62 | $0 |
Insurance plans in this area (ZIP 61704)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IL | |
| Clinical Psychologist | IL | |
| Hospitalist, Family Practice | TX | |
| Clinical Psychologist | IL | |
| Cardiovascular Disease (Cardiology) | IL | |
| Cardiovascular Disease (Cardiology) | IL | |
| - | IL | |
| Diagnostic Radiology | IL | |
| Physician Assistant | IL | |
| Physician Assistant | IL |
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