NPIMap

Individual provider Active NPI

Brian S Jacobs, DO

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Jersey Shore, PA
National Provider Identifier
1215915111
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
OS014838 Issued in PA
Practice address
1020 Thompson St
Jersey Shore, PA 17740-1729
Phone
(570) 398-1991
Fax
(570) 398-4607
NPI assigned
Jan 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS014838 PA
Family Medicine Physician 207Q00000X 47004 MN
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X OS014838 PA Primary

Addresses

Primary practice location

1020 Thompson St
Jersey Shore, PA 17740-1729

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other identifiers 2

IdentifierTypeStateIssuer
670998200MedicaidMN
102381212MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bjacobs85749@direct.geisinger.edu Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091111000303 PA Practitioner - Sports MedicinePractitioner - Family Practice 6406817733 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports Medicine
Education
Philadelphia College of Osteopathic Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Keystone Rehabilitation Systems IncGroup PAC ID 7012826753, shared by 15 NPIs, 750 clinicians

Practice addresses (Care Compare)

1020 Thompson St
Jersey Shore, PA 17740-1729
Phone (570) 398-3113

2000 Westinghouse Dr
Cranberry Township, PA 16066-5238

205 Hampton Ave
Punxsutawney, PA 15767-2133
Phone (814) 938-0148

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47004MNMDFamily Medicine Physician
OS014838PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic CurrentSince Aug 15, 2019 Accepting new patients
Geisinger-HM Joint Venture, LLC Family Medicine Current Accepting new patients
Geisinger-HM Joint Venture, LLC Family Medicine CurrentSince Jan 1, 2022 Accepting new patients
Geisinger Clinic Family Medicine Current Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Jan 1, 2022 Accepting new patients
Geisinger Clinic Family Medicine CurrentSince Aug 15, 2019 Accepting new patients
Geisinger Clinic Past Accepting new patients
Pinecroft Medical Center Family Medicine PastSince Feb 25, 2017 Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

1020 Thompson St
Jersey Shore, PA 17740
Phone (570) 398-0100

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

255 Route 220 Hwy
Muncy, PA 17756
Phone (570) 308-2600

132 Abigail Ln
Port Matilda, PA 16870
Phone (814) 272-5011

611 University Dr
State College, PA 16801
Phone (814) 234-2600

Interoperability endpoints

  • Direct secure messaging: bjacobs85749@direct.geisinger.edu

Organizations & group practices 8

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 35

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1215915111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 THOMPSON ST",
            "city": "JERSEY SHORE",
            "state": "PA",
            "postal_code": "177401729",
            "telephone_number": "570-398-1991",
            "fax_number": "570-398-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "BRIAN",
        "middle_name": "S",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS014838",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "47004",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "PA",
            "license": "OS014838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "670998200",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102381212",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bjacobs85749@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1020 Thompson St",
            "city": "Jersey Shore",
            "state": "PA",
            "country_code": "US",
            "postal_code": "177401729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jersey Shore, PA

Sources for this page

Verify at the official NPI Registry.