NPIMap

Individual provider Active NPI

Lirin Jacob, M.D.

  • Internal Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1063830263
Registry record updated Jul 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
33985 Issued in OK
Practice address
4300 W Memorial Rd
Oklahoma City, OK 73120
Phone
(405) 936-5800
Fax
(405) 936-5810
NPI assigned
Apr 3, 2014
Last updated
Jul 27, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11017670A IN
Internal Medicine Physician 207R00000X 33985 OK Primary

Addresses

Primary practice location

4300 W Memorial Rd
Oklahoma City, OK 73120

Mailing address

4300 W Memorial Rd
Oklahoma City, OK 73120-8304
Phone (405) 936-5800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180726000520 OK Practitioner - Internal Medicine 0244456721 Reassigns benefits to 11 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Oklahoma College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Hospital Kingfisher, IncGroup PAC ID 5395970180, shared by 3 NPIs, 10 clinicians
Mercy Hospital Logan County, IncGroup PAC ID 4587836200, 25 clinicians
Mercy Hospital Healdton IncGroup PAC ID 3375610447, shared by 4 NPIs, 13 clinicians
Mercy Hospital Watonga IncGroup PAC ID 6305002759, 6 clinicians

Practice addresses (Care Compare)

1000 Hospital Dr
Kingfisher, OK 73750-5029
Phone (405) 375-3141

200 S Academy Rd
Guthrie, OK 73044-8727
Phone (405) 282-6700

3462 Hospital Rd
Healdton, OK 73438-6124
Phone (580) 229-0701

500 N Clarence Nash Blvd
Watonga, OK 73772-2845
Phone (580) 623-7211

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11017670AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Kingfisher, Inc Current Accepting new patients
Mercy Hospital Kingfisher, Inc CurrentSince Mar 1, 2019 Accepting new patients
Mercy Hospital Logan County Inc CurrentSince Mar 1, 2019 Accepting new patients
Mercy Clinic Oklahoma Communities Family Medicine CurrentSince Aug 13, 2018 Accepting new patients
Mercy Hospital Healdton, Inc. CurrentSince Aug 30, 2022 Accepting new patients
Mercy Hospital Watonga Inc CurrentSince Mar 1, 2019 Accepting new patients
Mercy Hospital Healdton, Inc Current Accepting new patients
Mercy Hospital Healdton, Inc. Current Accepting new patients
Mercy Hospital Tishomingo, Inc. CurrentSince Mar 1, 2019 Accepting new patients
Mercy Hospital Logan County, Inc CurrentSince Mar 1, 2019 Accepting new patients
Mercy Hospital Tishomingo, Inc. Current Accepting new patients
Mercy Hospital Tishomingo, Inc CurrentSince Mar 1, 2019 Accepting new patients

Locations

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

3462 Hospital Rd
Healdton, OK 73438
Phone (580) 229-0701

1000 Hospital Dr
Kingfisher, OK 73750
Phone (405) 375-3141

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

1000 S Byrd St
Tishomingo, OK 73460
Phone (580) 371-2327

500 N Clarence Nash Blvd
Watonga, OK 73772
Phone (580) 623-2233

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532649600000",
    "number": "1063830263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 W MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208304",
            "telephone_number": "405-936-5800",
            "fax_number": "405-936-5810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 W MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73120",
            "telephone_number": "405-936-5800",
            "fax_number": "405-936-5810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "LIRIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-03",
        "last_updated": "2018-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11017670A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "33985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.