NPIMap

Individual provider Active NPI

Priscilla Jacobs, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1073109963
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9114395 Issued in FL
Practice address
6885 Belfort Oaks PL Ste 110
Jacksonville, FL 32216-6281
Phone
(904) 652-0373
Fax
(904) 652-0378
NPI assigned
Dec 15, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9114395 FL Primary
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X PA9114395 FL

Addresses

Primary practice location

6885 Belfort Oaks PL Ste 110
Jacksonville, FL 32216-6281

Mailing address

6885 Belfort Oaks PL Ste 110
Jacksonville, FL 32216-6281
Phone (904) 652-0373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20231213000250 FL Practitioner - Physician Assistant 2365891595 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
FWC Urogynecology LLCGroup PAC ID 8022276542, 16 clinicians

Practice addresses (Care Compare)

32801 US Hwy 19 N
Palm Harbor, FL 34684-3105
Phone (727) 724-1966

5323 4TH Ave Circle E
Bradenton, FL 34208-5623
Phone (941) 745-5115

Hospital & facility affiliations

  • HCA Florida Orange Park Hospital Hospital, Orange Park, FL, CCN 100226
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001
  • Baptist Medical Center - Nassau Hospital, Fernandina Beach, FL, CCN 100140
  • Brooks Rehabilitation Hospital University Campus Inpatient rehabilitation facility, Jacksonville, FL, CCN 103039

Merit-based Incentive Payment System (MIPS)

Final score
88.76 of 100Reported as group
Quality
84.84
Promoting interoperability
100
Improvement activities
40
Cost
77.7

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Womencare PA Past Accepting new patients

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: priscilla.jacobs.1@2183.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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": "1607990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1073109963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6885 BELFORT OAKS PL STE 110",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166281",
            "telephone_number": "904-652-0373",
            "fax_number": "904-652-0378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6885 BELFORT OAKS PL STE 110",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166281",
            "telephone_number": "904-652-0373",
            "fax_number": "904-652-0378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "PRISCILLA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-15",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9114395",
            "primary": true
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "FL",
            "license": "PA9114395",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.