Individual provider Active NPI

Ronald Stewart Jacobson, PHD

  • Clinical Psychologist
  • Virginia Beach, VA
National Provider Identifier
1063465870
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0810000305 Issued in VA
Practice address
2580 Potters Rd
Virginia Beach, VA 23454-4324
Phone
(757) 498-9391
Fax
(757) 498-7073
NPI assigned
May 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 0810000305 VA Primary

Addresses

Primary practice location

2580 Potters Rd
Virginia Beach, VA 23454-4324

Mailing address

2580 Potters Rd
Virginia Beach, VA 23454-4324
Phone (757) 498-9391

Other identifiers 3

IdentifierTypeStateIssuer
257774OtherVAANTHEM BCBS
O83564OtherVASENTARA/OPTIMA HEALTH CAR
00704143MedicaidVA

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0810000305VAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hampton Roads Neuropsychology PastSince Apr 15, 2020 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1063465870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2580 POTTERS RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234544324",
            "telephone_number": "757-498-9391",
            "fax_number": "757-498-7073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2580 POTTERS RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234544324",
            "telephone_number": "757-498-9391",
            "fax_number": "757-498-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "RONALD",
        "middle_name": "STEWART",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810000305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "257774",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA/OPTIMA HEALTH CAR",
            "identifier": "O83564",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00704143",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.