Individual provider Active NPI

Stuart Jacobson, MD

  • Diagnostic Radiology Physician
  • Lawrenceville, GA
National Provider Identifier
1184609380
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
34164 Issued in GA
Practice address
1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Phone
(678) 312-4440
NPI assigned
Dec 9, 2005
Last updated
Apr 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 34164 GA Primary

Addresses

Primary practice location

1000 Medical Center Blvd
Lawrenceville, GA 30046-7694

Mailing address

PO Box 1746
Indianapolis, IN 46206-1746
Phone (877) 383-4442

Other identifiers 2

IdentifierTypeStateIssuer
00466595MedicaidGA
300043417OtherGARR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20060815000024 GA Practitioner - Diagnostic Radiology 4789687666 Reassigns benefits to 1 organization
I20220819001549 FL Practitioner - Diagnostic Radiology 4789687666 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Vanderbilt University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Metropolitan Radiology Associates LLPGroup PAC ID 7214825561, 45 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (770) 237-1428

130 Senora CT
St Augustine, FL 32095-4838
Phone (404) 881-1117

2078 Teron Trce
Suite 200
Dacula, GA 30019-1606
Phone (678) 312-8600

3620 Howell Ferry Rd
Duluth, GA 30096-3178
Phone (678) 312-6800

3805 Pleasant Hill Rd
Duluth, GA 30096-4808
Phone (678) 312-7316

631 Professional Dr
Suite 250
Lawrenceville, GA 30046-3370
Phone (678) 312-0900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.01 of 100Reported as group
Quality
90
Improvement activities
40
Cost
68.37

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34164GAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Metropolitan Radiology Associates, LLP Diagnostic Radiology CurrentSince Jul 1, 1966 Accepting new patients

Locations

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1184609380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1746",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462061746",
            "telephone_number": "877-383-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER BLVD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300467694",
            "telephone_number": "678-312-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-09",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "34164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00466595",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "300043417",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.