Active NPI
Edward E Jacobson, MD
- Obstetrics & Gynecology Physician
- Longview, TX
National Provider Identifier
1013984319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- E2633
- Practice address
- 1111 N 6TH St
Longview, TX 75601-5537 - Phone
- (903) 758-0731
- Fax
- (903) 758-1369
- NPI assigned
- Mar 6, 2006
- Last updated
- Sep 6, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | E2633 | TX | Primary |
Addresses
Primary practice location
1111 N 6TH St
Longview, TX 75601-5537
Mailing address
PO Box 847176
Dallas, TX 75284-7176
Phone (903) 237-1800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 129543807 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diagnostic Clinic of Longview PA | Obstetrics & Gynecology | Past | Accepting new patients |
| Regional Clinics of Longview | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/23550/brand/1/csg/1/fhir/r4
Organizations & group practices 2
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.
-
- Internal Medicine Physician
- Longview, TX
- NPI 1386638468
Obstetrics & Gynecology
-
- Internal Medicine Physician
- Longview, TX
- NPI 1407047863
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346889600000",
"number": "1013984319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 847176",
"city": "DALLAS",
"state": "TX",
"postal_code": "752847176",
"telephone_number": "903-237-1800",
"fax_number": "903-237-1810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 N 6TH ST",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756015537",
"telephone_number": "903-758-0731",
"fax_number": "903-758-1369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "EDWARD",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-06",
"last_updated": "2012-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "TX",
"license": "E2633",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "129543807",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.