NPIMap

Individual provider Active NPI

Jeffrey T Jacob, MD

  • Neurological Surgery Physician
  • Royal Oak, MI
National Provider Identifier
1073715686
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
4301108040 Issued in MN
Practice address
3555 W 13 Mile Rd Ste N220
Royal Oak, MI 48073-6710
Phone
(248) 784-3667
Fax
(248) 869-3982
NPI assigned
Jun 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 4301108040 MN Primary

Addresses

Primary practice location

3555 W 13 Mile Rd Ste N220
Royal Oak, MI 48073-6710

Mailing address

29275 Northwestern Hwy Ste 100
Southfield, MI 48034-5700
Phone (248) 784-3667

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jeffrey.jacob.p1@direct.mhsineuro.nextgenshare.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20150619001619 MI Practitioner - Neurosurgery 3577624980 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Mayo Medical School, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Neurosurgical Associates PCGroup PAC ID 9739139759, 34 clinicians

Practice addresses (Care Compare)

15670 Southfield Rd
Allen Park, MI 48101-2513
Phone (877) 784-3667

29275 Northwestern Hwy
Suite 100
Southfield, MI 48034-5700
Phone (248) 351-6300

3555 W 13 Mile Rd
Suite N220
Royal Oak, MI 48073-6710
Phone (248) 268-5980

Hospital & facility affiliations

  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089
  • Ascension Providence Hospital, Southfield and Novi Hospital, Southfield, MI, CCN 230019
  • Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269
  • McLaren Port Huron Hospital, Port Huron, MI, CCN 230216

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301108040MNMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Neurosurgical Associates, PC Neurological Surgery CurrentSince Jul 1, 2015 Accepting new patients
University Neurosurgical Associates PC Current Accepting new patients
University Neurosurgical Associates PC Neurological Surgery CurrentSince Jul 1, 2015 Accepting new patients
William Beaumont Hospital Past Accepting new patients
University Neurosurgical Associates Neurological Surgery Past Accepting new patients

Locations

2319 Momentum Pl
Chicago, IL 60689

46325 W Twelve Mile Rd
Ste 100
Novi, MI 48377
Phone (248) 618-2121

3555 W 13 Mile Rd
Ste N220
Royal Oak, MI 48073
Phone (248) 268-5980

29275 Northwestern Hwy
Ste 100
Southfield, MI 48034
Phone (248) 351-6300

Interoperability endpoints

  • Direct secure messaging: jtjacob@direct.dmc.org
  • Direct secure messaging: jjacob1133134@direct.hfhs.org

Organizations & group practices 5

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 6

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": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1073715686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29275 NORTHWESTERN HWY STE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480345700",
            "telephone_number": "248-784-3667",
            "fax_number": "248-869-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 W 13 MILE RD STE N220",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736710",
            "telephone_number": "248-784-3667",
            "fax_number": "248-869-3982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JEFFREY",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-05",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MN",
            "license": "4301108040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeffrey.jacob.p1@direct.mhsineuro.nextgenshare.com",
            "affiliation": "N",
            "address_1": "3555 W 13 Mile Rd Ste N220",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.