Active NPI
Ellen Jacobs, OT
- Occupational Therapist
- Santa Fe, NM
National Provider Identifier
1255458717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 265
- Practice address
- 55 Camerada Loop
Santa Fe, NM 87508-8232 - Phone
- (505) 466-2506
- NPI assigned
- Mar 22, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 265 | NM | Primary |
Addresses
Primary practice location
55 Camerada Loop
Santa Fe, NM 87508-8232
Mailing address
55 Camerada Loop
Santa Fe, NM 87508-8232
Phone (505) 466-2506
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J4176 | Medicaid | NM |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 265 | NM | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255458717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 CAMERADA LOOP",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875088232",
"telephone_number": "505-466-2506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 CAMERADA LOOP",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875088232",
"telephone_number": "505-466-2506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "ELLEN",
"name_prefix": "Ms.",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NM",
"license": "265",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "J4176",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Fe, NM
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.