Thomas Jacob, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

94597 Issued in GA

Practice address

760 Kennesaw Ave NW
Marietta, GA 30060-6909

Phone

(770) 427-0183

NPI assigned

Apr 25, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, GA2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment NPD
• The Regents of the University of California

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1235107566
  Medicare reassignment NPD
• UC Regents

  • Pediatrics Physician
  • Los Angeles, CA
  • NPI 1982667663
  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• The Regents of the University of California

  • Ambulatory Surgical Clinic/Center
  • Valencia, CA
  • NPI 1689200305
  NPD

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1215295449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 KENNESAW AVE NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606909",
            "telephone_number": "770-427-0183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 KENNESAW AVE NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606909",
            "telephone_number": "770-427-0183"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4201 Torrance Blvd Ste 660",
            "address_purpose": "LOCATION",
            "city": "Torrance",
            "state": "CA",
            "postal_code": "90503",
            "country_code": "US",
            "telephone_number": "310-373-4303",
            "fax_number": "310-375-1935",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Ucla Medical Plz Ste 265",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900957419",
            "country_code": "US",
            "telephone_number": "310-825-0867",
            "fax_number": "310-206-5146",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "757 Westwood Plz",
            "address_2": "B711 RRUMC",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900957419",
            "country_code": "US",
            "telephone_number": "310-267-9129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-25",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "131098",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "94597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tjacob521269@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "760 Kennesaw Ave NW",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300606909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mirna Jacob-Pintro, PA-C
• Alice B Jacob, RD, LD
• Anila Jacob, M.D.
• Mervin Jacob
• Stephen Chacko Jacob, M.D.
• Eric Jacobs, DMD
• Kari Ann Jacobs, PT
• Yewande Jacobs
• Gary M. Jacobson, M.D.
• Michelle Jacobson, CCC-SLP

• Pediatrics Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.