Jacob Scott

Primary specialty

Assistant Behavior AnalystTaxonomy code 106E00000X

License

0-18-8888

Practice address

790 Fuller Ave NE
Grand Rapids, MI 49503-1918

Phone

(616) 336-3909

Fax

(616) 336-8830

NPI assigned

Jul 19, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Hope Network Behavioral Health Services

  • Mental Illness Community Based Residential Treatment Facility
  • Nunica, MI
  • NPI 1043295934
  NPD (past)
• Hope Network Behavioral Health Services

  • Child & Adolescent Psychiatry Physician
  • Grand Rapids, MI
  • NPI 1104128602
  NPD (past)

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

{
    "created_epoch": "1468886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1114370889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031918",
            "telephone_number": "616-336-3909",
            "fax_number": "616-336-8830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031918",
            "telephone_number": "616-336-3909",
            "fax_number": "616-336-8830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2814 Woodcliff Cir SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "49506",
            "country_code": "US",
            "telephone_number": "855-832-6727",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3361 36th St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "49512",
            "country_code": "US",
            "telephone_number": "616-942-2522",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3361 36th St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "49512",
            "country_code": "US",
            "telephone_number": "616-942-2522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-19",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": "0-18-8888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pcerecords.network180.x@direct.mihin.net",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "790 Fuller Ave NE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495031918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chawnee Scott
• Daniel Charles Scott, LMSW, LCSW
• Elizabeth Ann Scott, OTR
• Elizabeth Joy Scott, DNP, NP-C
• Emily Kathleen Scott, M.D.
• Jacob P Scott, MD
• James Scott
• Jonathan David Scott
• Keili Scott, M.A., BCBA, LBA
• Kiera Scott

• Assistant Behavior Analyst in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Assistant Behavior Analyst in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.