Wells C Jacobson, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

022276 Issued in CT

Practice address

36 Haynes St
Manchester, CT 06040-4105

Phone

(860) 646-0188

Fax

(860) 645-9573

NPI assigned

Apr 14, 2006

Last updated

Feb 24, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Manchester Orthopedic Surgery & Sport Medicine

  • Specialist
  • Manchester, CT
  • NPI 1265459077
  NPD (past) Authorized official

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235433600000",
    "number": "1245294214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 HAYNES ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404105",
            "telephone_number": "860-646-0188",
            "fax_number": "860-645-9573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 HAYNES ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404105",
            "telephone_number": "860-646-0188",
            "fax_number": "860-645-9573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "WELLS",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2009-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CT",
            "license": "022276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001222769",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Jackson
• Nicole M. Jackson, MD
• Reginald Jackson
• Shannon Jackson, PSY.D.
• John Jacob
• Jennifer Michelle Jahn
• Hira C Jain, M.D.
• Jamshid a Marvasti, M.D. P.C.
• Anna Jankowski, PHARM.D
• Briana Lyn Japs, RDH, MPH

• Orthopaedic Surgery Physician in Manchester, CT
• Providers in Manchester, CT by specialty
• Orthopaedic Surgery Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.