Jacob Iceberg, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101026922 Issued in MI

Practice address

280 60TH St SE # 200
Grand Rapids, MI 49548-8504

Phone

(616) 483-0750

NPI assigned

Jun 19, 2020

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

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Family Practice

Education

Des Moines University of Osteopathic Medicine and Health Sciences, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Catherine'S Health CenterGroup PAC ID 2860615838, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacob.iceberg.1@8492.direct.athenahealth.com

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.

• Catherine'S Health Center

  • Clinic/Center
  • Grand Rapids, MI
  • NPI 1912055872
  Medicare reassignment Care Compare group NPD
• Catherine'S Health Center

  • Federally Qualified Health Center (FQHC)
  • Grand Rapids, MI
  • NPI 1407742018
  NPD
• Catherines Health Center

  • Federally Qualified Health Center (FQHC)
  • Grand Rapids, MI
  • NPI 1669074415
  NPD
• Catherine'S Health Center

  • Federally Qualified Health Center (FQHC)
  • Grand Rapids, MI
  • NPI 1811427826
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1043836612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 60TH ST SE # 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495488504",
            "telephone_number": "616-483-0750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 60TH ST SE # 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495488504",
            "telephone_number": "616-483-0750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Lafayette Ave SE Ste 4000",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495034692",
            "country_code": "US",
            "telephone_number": "616-685-6922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ICEBERG",
        "first_name": "JACOB",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-19",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101026922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victor Ibarra
• Eniola Raheem Ibirogba, M.B.B.S.
• Gena Ibrahim, MD
• Yahya Amer Ibrahim, MD
• Melonie Sue Ice, M.D.
• Quinn Alyse Icke
• Joanne Karen Ickstadt, P.T.
• Sonnia Idoko, MD
• Tiffany Idziak
• John Leroy Iehl, PA

• Family Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.