Kaleb L. Jacobs, D.O.
Individual provider Active NPI Obstetrics & Gynecology Physician · Peoria, IL
NPI 1124468129 · NPPES record last updated Sep 6, 2024
Key facts
- NPI
- 1124468129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 036142613 (IL)
- Practice address
- 530 NE Glen Oak Ave
Peoria, IL 61637-0001 - Phone
- (309) 655-3024
- Fax
- (309) 655-3739
- NPI assigned
- Jul 5, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 33
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Board of Trustees of the University of Illinois
Heartland Community Health Clinic
Practice addresses (Care Compare)
1 Illini Dr
Peoria, IL 61605-2576
Phone (309) 671-3173
1800 N Knoxville Ave
Suite a
Peoria, IL 61603-3005
Phone (309) 680-7600
Hospital & facility affiliations
- Saint Francis Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.28 of 100
- Quality
- 73.53
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 70.73
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171024000488 | IL | Practitioner - Obstetrics/Gynecology | 1557682168 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036142613 | IL | MD | Obstetrics & Gynecology Physician |
| 125.063154 | IL | MD | Obstetrics & Gynecology Physician |
| R-34-2015 | NM | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teverbaugh Croland & Mueller OB/GYN & Associates, S.C. | Obstetrics & Gynecology | Current | Accepting new patients |
| The Board of Trustees of the University of Illinois | Current | Accepting new patients | |
| Board of Trustees of the University of Illinois | Current |
Accepting new patients | |
| The Board of Trustees of the University of Illinois | Current |
Accepting new patients | |
| Heartland Community Health Clinic | Past | Accepting new patients | |
| Heartland Community Health Clinic | Past | Accepting new patients |
Locations
7694 Solutions Ctr
Chicago, IL 60677
530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553
6708 N Knoxville Ave
Ste 1
Peoria, IL 61614
Phone (309) 691-6868
1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | R-34-2015 | NM | |
| Obstetrics & Gynecology Physician | 207V00000X | 125.063154 | IL | |
| Obstetrics & Gynecology Physician | 207V00000X | 036142613 | IL | Yes |
Addresses
Primary practice location
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Mailing address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 655-3024
Other practice location 1
1800 N Knoxville Ave Ste A
Peoria, IL 61603-3005
Phone (309) 680-7600
Other providers in Peoria, IL
- Kavitha S Jacob
- Lissiamma Jacob
- Nirmal Tom Jacob
- Raji Jacob
- Sarah Lynn Jacob
- Zachary Michael Jacobs
- Renaldo A Jacques
- Courtney M Jaegle
- Asim K Jaffer
- Nazish Hasan Jafri
All providers in Peoria, IL · Obstetrics & Gynecology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.