Active NPI
Stephen B Jacobs, MD
- Pediatrics Physician
- Yarmouth, ME
National Provider Identifier
1053391748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 011883
- Practice address
- 259 Main St
Yarmouth, ME 04096-6723 - Phone
- (207) 846-9602
- Fax
- (207) 523-8586
- NPI assigned
- Jan 19, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 011883 | ME | Primary |
Addresses
Primary practice location
259 Main St
Yarmouth, ME 04096-6723
Mailing address
100 Gannett Dr Ste C
South Portland, ME 04106-5900
Phone (207) 523-3649
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011883 | ME | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541721600000",
"number": "1053391748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 GANNETT DR STE C",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041065900",
"telephone_number": "207-523-3649",
"fax_number": "207-874-1483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "259 MAIN ST",
"city": "YARMOUTH",
"state": "ME",
"postal_code": "040966723",
"telephone_number": "207-846-9602",
"fax_number": "207-523-8586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "STEPHEN",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-19",
"last_updated": "2018-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "ME",
"license": "011883",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yarmouth, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.