Active NPI
Mary Ann Jacob, M.D.
- Pediatrics Physician
- Anchorage, AK
National Provider Identifier
1194741041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 3150
- Practice address
- 2841 Debarr Rd
Suite 45
Anchorage, AK 99508-2932 - Phone
- (907) 274-0274
- NPI assigned
- Jul 14, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 3150 | AK | Primary |
Addresses
Primary practice location
2841 Debarr Rd
Suite 45
Anchorage, AK 99508-2932
Mailing address
2841 Debarr Rd
Suite 45
Anchorage, AK 99508-2932
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD04901 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3150 | AK | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mary Ann Jacob, M.D., LLC | Pediatrics | Past | Accepting new patients |
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.
-
- Pediatrics Physician
- Anchorage, AK
- NPI 1437462363
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194741041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2841 DEBARR RD",
"address_2": "SUITE 45",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995082932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2841 DEBARR RD",
"address_2": "SUITE 45",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995082932",
"telephone_number": "907-274-0274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "MARY",
"middle_name": "ANN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AK",
"license": "3150",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MD04901",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.