Individual provider Active NPI

Scott Bentley Jacobs, M.D.

  • Emergency Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1265483226
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
G071885 Issued in CA
Practice address
11301 Wilshire Blvd
Building 500, RM 1129, Mail Route 111G
Los Angeles, CA 90073
Phone
(310) 478-3711
NPI assigned
May 15, 2006
Last updated
Jan 13, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G071885 CA Primary

Addresses

Primary practice location

11301 Wilshire Blvd
Building 500, RM 1129, Mail Route 111G
Los Angeles, CA 90073

Mailing address

2510 Jalmia Dr
Los Angeles, CA 90046-1716
Phone (323) 216-0006

Other identifiers 1

IdentifierTypeStateIssuer
00G718850MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20050811000799 CA Practitioner - Emergency Medicine 0941239644 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G071885CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Victory Emergency Physicians Medical Group Inc Emergency Medicine CurrentSince Jan 1, 2011 Accepting new patients
Louisiana Emergency & Trauma Specialists Emergency Medicine Past Accepting new patients
Ortho Urgent Care Medical Group, Inc. Past Accepting new patients

Locations

1720 E Cesar E Chavez Ave
Los Angeles, CA 90033
Phone (323) 260-5781

1720 E Cesar E Chavez Ave
#C
Los Angeles, CA 90033
Phone (213) 268-5000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1265483226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 JALMIA DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900461716",
            "telephone_number": "323-216-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD",
            "address_2": "BUILDING 500, RM 1129, MAIL ROUTE 111G",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90073",
            "telephone_number": "310-478-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "SCOTT",
        "middle_name": "BENTLEY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G071885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G718850",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.