Active NPI
Marileen Ann Jacobs
- Orthotic Fitter
- Coeur D Alene, ID
National Provider Identifier
1023019494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthotic Fitter
- Practice address
- 1512 E Gilbert Ave
Coeur D Alene, ID 83815-6216 - Phone
- (208) 664-4398
- Fax
- (208) 667-4733
- NPI assigned
- Aug 9, 2005
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthotic Fitter | 225000000X | Primary |
Addresses
Primary practice location
1512 E Gilbert Ave
Coeur D Alene, ID 83815-6216
Mailing address
1512 E Gilbert Ave
Coeur D Alene, ID 83815-6216
Phone (208) 664-4398
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8A760 | Other | ID | BLUE CROSS |
| 000010014587 | Other | ID | REGENCE BLUE SHIELD |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023019494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1512 E GILBERT AVE",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838156216",
"telephone_number": "208-664-4398",
"fax_number": "208-667-4733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1512 E GILBERT AVE",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838156216",
"telephone_number": "208-664-4398",
"fax_number": "208-667-4733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "MARILEEN",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225000000X",
"taxonomy_group": "",
"desc": "Orthotic Fitter",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "8A760",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "000010014587",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coeur D Alene, ID
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.