Individual provider Active NPI

Bradley S Jacobs, MD

  • Neurology Physician
  • Dayton, OH
National Provider Identifier
1104882976
Registry record updated Apr 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
35-086454 Issued in OH
Practice address
30 E Apple St Ste 5254a
Dayton, OH 45409-2939
Phone
(937) 208-4200
Fax
(937) 208-4205
NPI assigned
Apr 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 35-086454 OH Primary

Addresses

Primary practice location

30 E Apple St Ste 5254a
Dayton, OH 45409-2939

Mailing address

30 E Apple St Ste 5254a
Dayton, OH 45409-2939
Phone (937) 208-4200

Other identifiers 1

IdentifierTypeStateIssuer
2633823MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060504001005 OH Practitioner - Neurology 0648281634 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Ohio State University College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Health Specialists IncGroup PAC ID 5597708594, 576 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
Middletown, OH 45005-2584
Phone (513) 974-2111

1 Wyoming St
Dayton, OH 45409-2722

1 Wyoming St
Berry Women'S Center Labor and Delivery
Dayton, OH 45409-2939
Phone (937) 439-4381

30 E Apple St
Dayton, OH 45409-2939

3130 N Count Rd
Troy, OH 45373-1337

450 N Hyatt St
Suite 304
Tipp City, OH 45371-1433
Phone (937) 832-4773

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.38 of 100Reported as group
Quality
66.25
Promoting interoperability
100
Improvement activities
40
Cost
71.69

Merit-based Incentive Payment System (MIPS)

Final score
84.17 of 100Reported as group
Quality
65.6
Promoting interoperability
100
Improvement activities
40
Cost
74.7

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-086454OHMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Health Specialists Inc Current Accepting new patients
Premier Health Specialists Inc CurrentSince May 1, 2013 Accepting new patients
Premier Health Specialists Inc CurrentSince May 1, 2013 Accepting new patients
Harper Hutzel Hospital Past Accepting new patients
Premier Heart Associates, Inc Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

30 E Apple St
Ste 5254A
Dayton, OH 45409

1 Wyoming St
Dayton, OH 45409
Phone (937) 208-2636

1 Wyoming St
Ste G2688
Dayton, OH 45409

30 E Apple St
Ste 5254
Dayton, OH 45409
Phone (844) 277-2894

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

Organizations & group practices 6

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 3

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": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429488000000",
    "number": "1104882976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E APPLE ST STE 5254A",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092939",
            "telephone_number": "937-208-4200",
            "fax_number": "937-208-4205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E APPLE ST STE 5254A",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092939",
            "telephone_number": "937-208-4200",
            "fax_number": "937-208-4205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "BRADLEY",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2015-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OH",
            "license": "35-086454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2633823",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.