NPIMap

Individual provider Active NPI

Bradley Edgar Jacobs, MD

  • Obstetrics & Gynecology Physician
  • Winston-Salem, NC
National Provider Identifier
1194721498
Registry record updated Nov 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
9801681 Issued in NC
Practice address
2927 Lyndhurst Ave
Winston-Salem, NC 27103-4005
Phone
(336) 765-9350
Fax
(336) 760-4255
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 9801681 NC Primary

Addresses

Primary practice location

2927 Lyndhurst Ave
Winston-Salem, NC 27103-4005

Mailing address

2927 Lyndhurst Ave
Winston-Salem, NC 27103-4005
Phone (336) 765-9350

Other identifiers 2

IdentifierTypeStateIssuer
891280KMedicaidNC
1280KOtherNCBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120110000851 NC Practitioner - Obstetrics/Gynecology 7416123609 Reassigns benefits to 1 organization
I20190403000455 NY Practitioner - Obstetrics/Gynecology 7416123609 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Alabama School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Albany Medical CollegeGroup PAC ID 1759293111, 1,054 clinicians

Practice addresses (Care Compare)

47 New Scotland Ave
Albany, NY 12208-3412
Phone (518) 262-5633

Hospital & facility affiliations

  • Albany Medical Center Hospital Hospital, Albany, NY, CCN 330013

Merit-based Incentive Payment System (MIPS)

Final score
88.25 of 100Reported as group
Quality
82.32
Promoting interoperability
100
Improvement activities
40
Cost
78.52

Merit-based Incentive Payment System (MIPS)

Final score
87.78 of 100Reported as group
Quality
77.53
Promoting interoperability
100
Improvement activities
40
Cost
76.35

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal or shaving of skin growth1-10
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Memorial Hospital CurrentSince Jun 24, 2022 Accepting new patients
Columbia Memorial Hospital Current Accepting new patients
Albany Medical College CurrentSince Mar 30, 2019 Accepting new patients
Uwh of the Carolinas, PLLC Obstetrics & Gynecology CurrentSince Jan 14, 2014 Accepting new patients
Albany Medical College Obstetrics & Gynecology CurrentSince Mar 30, 2019 Accepting new patients
Albany Medical College Obstetrics & Gynecology CurrentSince Aug 13, 2023 Accepting new patients
Albany Medical College Obstetrics & Gynecology Current Accepting new patients
Columbia Memorial Hospital CurrentSince Jun 24, 2022 Accepting new patients
Albany Medical College Past Accepting new patients

Locations

3015 Maplewood Ave
Ste 202
Winston Salem, NC 27103

111 Hanestown Ct
#151
Winston Salem, NC 27103
Phone (919) 334-0150

2927 Lyndhurst Ave
Winston Salem, NC 27103
Phone (336) 277-1650

1806 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 768-3632

391 Myrtle Ave
Ste 2
Albany, NY 12208
Phone (518) 262-4942

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

16 New Scotland Ave
Albany, NY 12208
Phone (518) 262-4942

71 Prospect Ave
Hudson, NY 12534
Phone (518) 262-3773

1275 Broadway
Menands, NY 12204
Phone (518) 262-9705

377 Church St
Saratoga Springs, NY 12866
Phone (518) 203-2582

2827 US Highway 9
Valatie, NY 12184
Phone (518) 828-7601

Interoperability endpoints

  • Direct secure messaging: bjacobs25711@albanymed.direct-ci.com

Organizations & group practices 9

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.

Hospital & facility affiliations 5

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": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321401600000",
    "number": "1194721498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2927 LYNDHURST AVE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271034005",
            "telephone_number": "336-765-9350",
            "fax_number": "336-760-4255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2927 LYNDHURST AVE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271034005",
            "telephone_number": "336-765-9350",
            "fax_number": "336-760-4255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "BRADLEY",
        "middle_name": "EDGAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2011-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "9801681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891280K",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1280K",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston-Salem, NC

Sources for this page

Verify at the official NPI Registry.