Mark Jacobs, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MD020668E Issued in PA

Practice address

1010 West Chester Pike
Suite #202
Havertown, PA 19083-3442

Phone

(610) 789-3510

Fax

(610) 789-3591

NPI assigned

Jun 24, 2006

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 PA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Prospect Health Access Network, Inc.

  • Emergency Medicine Physician
  • Chester, PA
  • NPI 1568819084
  Medicare reassignment NPD
• Prospect Health Access Network, Inc.

  • Diagnostic Radiology Physician
  • Chester, PA
  • NPI 1154776797
  NPD
• Prospect Health Access Network, Inc.

  • Hospitalist Physician
  • Ridley Park, PA
  • NPI 1235584731
  NPD

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424390400000",
    "number": "1013943885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 WEST CHESTER PIKE",
            "address_2": "SUITE #202",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190833442",
            "telephone_number": "610-789-3510",
            "fax_number": "610-789-3591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 WEST CHESTER PIKE",
            "address_2": "SUITE #202",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190833442",
            "telephone_number": "610-789-3510",
            "fax_number": "610-789-3591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2015-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "MD020668E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078331502",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsay Iser
• Merita K Jackson Hinds, OMD
• Lisa Ann Jackson, CRNA
• Charles Jason Jacob, PH.D.
• James L Jacobs
• Richard L. Jahnle, M.D.
• Shailen Jalali, MD
• James I. Weinberg, DO
• Sakthipriya Janarthanan, MD
• Regina Janda, CRNP

• Gastroenterology Physician in Havertown, PA
• Providers in Havertown, PA by specialty
• Gastroenterology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.