Ian M Jacobson, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

MD08888 Issued in RI

Practice address

825 Chalkstone Ave
Providence, RI 02908-4728

Phone

(330) 493-4443

NPI assigned

Feb 8, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JBICAA/Endpoint/JBICAA
• Direct secure messaging: ian.jacobson.p1@direct.bvchc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blackstone Valley Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pawtucket, RI
  • NPI 1063574135
  Medicare reassignment
• Blackstone Valley Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Central Falls, RI
  • NPI 1275847766
  NPD (past)
• Emergency Medicine Physicians of Providence County, LLC

  • Emergency Medicine Physician
  • Providence, RI
  • NPI 1194764019
  NPD (past)
• Melrose Wakefield Emergency Physicians, Inc.

  • Emergency Medicine Physician
  • Melrose, MA
  • NPI 1790730539
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013057900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 DRESSLER RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182545",
            "telephone_number": "330-493-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 CHALKSTONE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084728",
            "telephone_number": "330-493-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "IAN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "RI",
            "license": "MD08888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7004811",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Isa Mulingbayan Jacoba, MD
• Elizabeth Anne Jacobs, MA
• Elizabeth S Jacobs, MD
• Ellen S Jacobs
• Alexis Jacobson, MD
• Grace Vivian Jacques, RN
• Danielle Jadin, LICSW
• Shadi Jafari-Esfahani, MD
• Jerri L Jaffa, RN, CDE
• Sharmeen Jaffry, DO

• Emergency Medicine Physician in Providence, RI
• Providers in Providence, RI by specialty
• Emergency Medicine Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.