JACOB WATERS – Speech-Language Pathologist, NPI 1568857035

JACOB WATERS is a healthcare provider. based in Boalsburg, Pennsylvania. specializing in QUALIFIED SPEECH LANGUAGE PATHOLOGIST. They hold a License No. 2202007850 (VA). The NPI Number for JACOB WATERS is 1568857035

Main info

Male
Sole Proprietor
11 Years Of Experience
Accepts Medicare Assignment
Name
JACOB WATERS
NPI
1568857035
Phone
(570) 506-7845
Address
304 HOMESTEAD LN APT 1
Enumeration Date
1 April 2015
Last Update Date
31 August 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8047153025
Graduation Year
2015 (11 years ago)
PAC ID
0345608071
Group Practice PAC ID
2163339722
Professional Enrollment ID
I20230628000104
Address ID
VA232353700NO11210RDXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience51
Completeness75
Years active:11State licenses:1Digital endpointsOther names

244 QUALIFIED SPEECH LANGUAGE PATHOLOGIST in VA

Provider Addresses for JACOB WATERS

  • 304 HOMESTEAD LN APT 1

    PO BOX 378

    BOALSBURG, PA 168271533

    Phone: (570) 506-7845

    Type: Mailing

  • 906 THOMPSON ST

    ASHLAND, VA 230051128

    Phone: (804) 798-3291

    Type: Location

  • 4716 WILCONNA RD

    CHESTERFIELD, VA 238327657

    Phone: (804) 528-9784

    Type: Mailing

  • 235 DUNLOP FARMS BLVD

    COLONIAL HEIGHTS, VA 238341792

    Phone: (804) 520-0050

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2023-06-28

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20230628000104IQualified Speech Language PathologistVATBD

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.

Verify on CMS Revalidation Lookup Tool

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 16827)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2163339722View full group profile
NameSpecialtyState
Internal MedicineVA
-NY
Nurse PractitionerMI
Family PracticeTX
Physician AssistantNC
Internal Medicine, Geriatric MedicineNC
Qualified Speech Language PathologistOK
Occupational Therapist In Private PracticeNC
Internal MedicineNC
Internal MedicineNC

Reviews

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Frequently asked questions

What is JACOB WATERS's NPI number?
JACOB WATERS's NPI is 1568857035 — the number used across U.S. healthcare to identify this provider.
Would JACOB WATERS appear as active to a payer?
You can treat JACOB WATERS as active for directory purposes; confirm clinical privileges separately.
How would a patient describe JACOB WATERS's focus?
For JACOB WATERS, the primary taxonomy reads as Speech-Language Pathologist. Clinical services aligned with this taxonomy classification.
Where in Pennsylvania is JACOB WATERS registered?
Use Boalsburg, Pennsylvania as the headline location for JACOB WATERS here.
Can I trust this NPI listing for JACOB WATERS?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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