Zachary Jakubik, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

5101024601 Issued in MI

Practice address

2520 E Dupont Rd
Fort Wayne, IN 46825-1675

Phone

(260) 416-3000

NPI assigned

Jun 14, 2018

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Emergency Professionals of Indiana, P.C.

  • Emergency Medicine Physician
  • Fort Wayne, IN
  • NPI 1013951219
  Medicare reassignment NPD

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

{
    "created_epoch": "1528934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1124512058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 GARDENIA AVE APT 4",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480672130",
            "telephone_number": "586-557-5036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251675",
            "telephone_number": "260-416-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAKUBIK",
        "first_name": "ZACHARY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-14",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101024601",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "02006550B",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0045751",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sushil Jain, MD
• Sushil K. Jain, MD
• Swarn Shubbi Jain, LMHC
• Suresh Jaiswal, M.D.
• Peter A. Jakacki, MD
• James a Shupe DDS, Dentistry for Children, Inc
• James a. Long, II O.D. Inc
• James C Ransbottom, M.D.
• James E. Dumas, DDS, PC
• James H Pennington OD

• Emergency Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Emergency Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.