NPIMap

Individual provider Active NPI

Jessie K Jacob, MD

  • Diagnostic Radiology Physician
  • Palo Alto, CA
National Provider Identifier
1083644223
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A107083 Issued in CA
Practice address
2421 Park Blvd Ste B202
Palo Alto, CA 94306-1956
Phone
(650) 617-8655
NPI assigned
Jul 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 242480 NY
Diagnostic Radiology Physician 2085R0202X A107083 CA Primary

Addresses

Primary practice location

2421 Park Blvd Ste B202
Palo Alto, CA 94306-1956

Mailing address

2421 Park Blvd Ste B202
Palo Alto, CA 94306-1956
Phone (650) 617-8655

Other identifiers 1

IdentifierTypeStateIssuer
A107083OtherCAMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20090916000722 CA Practitioner - Diagnostic Radiology 7315942836 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Vermont College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2421 Park Blvd
Suite B202
Palo Alto, CA 94306-1956
Phone (650) 617-8658

Hospital & facility affiliations

  • Stanford Health Care Hospital, Stanford, CA, CCN 050441

Merit-based Incentive Payment System (MIPS)

Final score
94.17 of 100Reported as individual
Quality
88.33
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Diana F Guthaner M D Inc CurrentSince Jan 3, 2021 Accepting new patients
Jessie Jacob MD Inc CurrentSince Dec 7, 2012 Accepting new patients
Phelps Imaging Services,P.C Past Accepting new patients
White Plains Radiology Associates PC Diagnostic Radiology Past Accepting new patients

Locations

2421 Park Blvd
Ste B202
Palo Alto, CA 94306
Phone (650) 617-8655

900 Welch Rd
Ste 101
Palo Alto, CA 94304
Phone (650) 493-6055

Organizations & group practices 4

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1083644223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2421 PARK BLVD STE B202",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943061956",
            "telephone_number": "650-617-8655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 PARK BLVD STE B202",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943061956",
            "telephone_number": "650-617-8655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JESSIE",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "242480",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A107083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "A107083",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

Verify at the official NPI Registry.