Marc Jacobson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2475-015 Issued in WI

Practice address

10521 N Port Washington Rd
Mequon, WI 53092-5584

Phone

(262) 241-2060

Fax

(262) 241-2064

NPI assigned

Jun 5, 2008

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 WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212624000000",
    "number": "1043479827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10521 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925584",
            "telephone_number": "262-241-2060",
            "fax_number": "262-241-2064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10521 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925584",
            "telephone_number": "262-241-2060",
            "fax_number": "262-241-2064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "MARC",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-05",
        "last_updated": "2008-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "2475-015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33412900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Irene Izzard, RRT
• Caitlin Rose Jacek, LCSW
• Ostassia Jackson
• Shawn A Jackson, SAC-IT
• Diana R Jacobs, DO
• Michaela Jagemann, OTR/L
• Gabriella Janke, PT, DPT
• Jennifer Janowitz, MS, LPC
• Anne Elizabeth Jaramillo, AU.D.
• Catherine Marie Payan Jasperson, M.S. CF-SLP

• Dentist in Mequon, WI
• Providers in Mequon, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; 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.