CARLEY A JACOBS (PA-C) – Physician Assistant, NPI 1093993560
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,429 PHYSICIAN ASSISTANT in VA
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Provider Addresses for CARLEY A JACOBS (PA-C)
761, South Main Street, Trap Corner, West Paris, Oxford County, Maine, 04219, United States
WOODSTOCK, VA 226641127
Phone: (540) 459-5112
Fax: (540) 459-3565
Type: Mailing
761 S Main St
Woodstock, VA 226641127
Phone: (540) 459-5112
Fax: (540) 459-3565
Type: Location
2300 KATI CT STE A
SHELTON, WA 985841926
Phone: (360) 426-0955
Type: Location
PO BOX 1668
SHELTON, WA 985845001
Phone: (360) 426-0955
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $22.
Total Amount is formed as General ($22) + Research ($0) + Ownership ($0) = $22.
Last reported payment date: 2024-03-13 • Largest payer in this snapshot: Hologic Sales and Service, LLC ($22).
Total Amount
$22
General + Research + Ownership
Payments
1
Total payment records
General Amount
$22
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-03-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Hologic Sales and Service, LLC | $22 |
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: 2012-11-28
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20121128000202 | I | Physician Assistant | WA | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 22664)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | CA | |
| Interventional Cardiology, Cardiovascular Disease (Cardiology), Interventional Cardiology | AK | |
| - | WA | |
| Certified Registered Nurse Anesthetist (Crna) | MN | |
| O B S T E T R I C S/ G Y N E C O L O G Y | WA | |
| Physician Assistant | WA | |
| Nurse Practitioner | PA | |
| Physician Assistant | WA | |
| Physician Assistant | WA | |
| Physician Assistant | UT |
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