Angela Renee Jacob, D.P.M.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

5901002584 Issued in MI

Practice address

6900 Orchard Lake Rd Ste 207
West Bloomfield, MI 48322-3425

Phone

(248) 963-0919

NPI assigned

May 29, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Optimal Care Home Health Home health agency, Bingham Farms, MI, CCN 237504
• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
• Henry Ford Health West Bloomfield Hospital Hospital, W Bloomfield, MI, CCN 230302

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ajacob365441@direct.hfhs.org
• FHIR API: https://fhir.hfhs.org/FHIRProxy/api/FHIR/R4/

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.

• Precision Foot and Ankle Center PLLC

  • Foot & Ankle Surgery Podiatrist
  • West Bloomfield, MI
  • NPI 1760110456
  Medicare reassignment NPD Authorized official
• Henry Ford Health System

  • Podiatrist
  • Detroit, MI
  • NPI 1396824207
  Medicare reassignment NPD
• Onsight, Inc.

  • Podiatrist
  • East Lansing, MI
  • NPI 1821248568
  Medicare reassignment NPD
• Henry Ford Health System

  • Anesthesiology Physician
  • Detroit, MI
  • NPI 1003989690
  NPD
• Henry Ford Health System

  • Community/Retail Pharmacy
  • Plymouth, MI
  • NPI 1942931720
  NPD
• Onsight, Inc.

  • Dentist
  • East Lansing, MI
  • NPI 1730339474
  NPD
• Giaimo Mobile Podiatry of WV PLLC

  • Podiatrist
  • Charleston, WV
  • NPI 1386183473
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Henry Ford Health System

  • General Acute Care Hospital
  • West Bloomfield, MI
  • NPI 1407867559
  Care Compare affiliation
• Optimal Care, LLC

  • Home Health Agency
  • Bingham Farms, MI
  • NPI 1588697841
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1124430806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 ORCHARD LAKE RD STE 207",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223425",
            "telephone_number": "248-963-0919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 ORCHARD LAKE RD STE 207",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223425",
            "telephone_number": "248-963-0919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "ANGELA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-29",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MI",
            "license": "5315080074",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MI",
            "license": "5901002584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124430806",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Jackson
• Lynn Jackson
• Payton Jackson III, LMSW
• Rodger Dale Jackson Jr., DO, MPH
• Jacob Kalo, M.D.
• Bruce Michael Jacob, D.P.M.
• Lisa Roselin Jacob, M.D.
• Dennis Joseph Jacobs, PH.D.
• Howard Paul Jacobs, RPH
• Kulsoom Jafri, O.D

• Foot & Ankle Surgery Podiatrist in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Foot & Ankle Surgery Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.