Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jacob (Jake) William Condren, PA-C

Individual provider Physician Assistant · NPI 1265971865

Jacob (Jake) William Condren, PA-C is a Physician Assistant in Bolivar, Missouri. Qualified in 2016, 10 years ago. Practices with Citizens Memorial Healthcare, a 145-clinician group and accepts Medicare assignment.

Years since qualifying
10
In the registry since
2017
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1155 W Parkview St Ste 2D
Bolivar, MO 65613-8279
Phone: (417) 777-2663
Fax: (417) 777-2666
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1265971865
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedFebruary 15, 2017
Last updated in NPPESFebruary 15, 2017

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Citizens Memorial Healthcare — 145 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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