Active NPI
Kenneth Lee Dine Jacobs, D.O.
- Emergency Medicine Physician
- Springfield, OH
National Provider Identifier
1285698670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 34.005854
- Practice address
- 2615 E High St
Springfield, OH 45505-1412 - Phone
- (937) 325-0531
- NPI assigned
- Apr 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 34.005854 | OH | Primary |
Addresses
Primary practice location
2615 E High St
Springfield, OH 45505-1412
Mailing address
3131 Newmark Dr Ste 210
Miamisburg, OH 45342-5400
Phone (937) 438-8910
Other practice location 1
1997 Miamisburg Centerville Rd
Centerville, OH 45459-3811
Phone (937) 401-6228
Other practice location 2
600 W Main St
Troy, OH 45373-3384
Phone (937) 980-7010
Other practice location 3
100 Kettering Way
Franklin, OH 45005-1155
Phone (937) 458-4700
Other practice location 4
3535 Pentagon Blvd
Beavercreek, OH 45431-1705
Phone (937) 702-4500
Other practice location 5
450 Washington Jackson Rd Ste F
Eaton, OH 45320-8699
Phone (937) 456-8376
Other practice location 6
3535 Southern Blvd
Kettering, OH 45429-1221
Phone (937) 395-8166
Other practice location 7
405 W Grand Ave
Dayton, OH 45405-7538
Phone (937) 723-3211
Other practice location 8
6147 State Route 122
Middletown, OH 45005-5201
Phone (513) 261-3410
Other practice location 9
1141 N Monroe Dr
Xenia, OH 45385-1619
Phone (937) 352-2500
Other practice location 10
8701 Old Troy Pike
Huber Heights, OH 45424-1066
Phone (937) 558-3338
Other practice location 11
4000 Miamisburg Centerville Rd
Miamisburg, OH 45342-7615
Phone (937) 384-8791
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0986116 | Medicaid | OH | |
| 000000017441 | Other | OH | ANTHEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Springfield Emergency Physicians, Inc. | Emergency Medicine | Past | Accepting new patients |
| Emergency Medicine Specialists Inc | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Miamisburg, OH
- NPI 1366428575
-
- Emergency Medicine Physician
- Springfield, OH
- NPI 1407810534
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595808000000",
"number": "1285698670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3131 NEWMARK DR STE 210",
"city": "MIAMISBURG",
"state": "OH",
"postal_code": "453425400",
"telephone_number": "937-438-8910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2615 E HIGH ST",
"city": "SPRINGFIELD",
"state": "OH",
"postal_code": "455051412",
"telephone_number": "937-325-0531"
}
],
"practiceLocations": [
{
"address_1": "1997 Miamisburg Centerville Rd",
"address_purpose": "LOCATION",
"city": "Centerville",
"state": "OH",
"postal_code": "454593811",
"country_code": "US",
"telephone_number": "937-401-6228",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "600 W Main St",
"address_purpose": "LOCATION",
"city": "Troy",
"state": "OH",
"postal_code": "453733384",
"country_code": "US",
"telephone_number": "937-980-7010",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "100 Kettering Way",
"address_purpose": "LOCATION",
"city": "Franklin",
"state": "OH",
"postal_code": "450051155",
"country_code": "US",
"telephone_number": "937-458-4700",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3535 Pentagon Blvd",
"address_purpose": "LOCATION",
"city": "Beavercreek",
"state": "OH",
"postal_code": "454311705",
"country_code": "US",
"telephone_number": "937-702-4500",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "450 Washington Jackson Rd Ste F",
"address_purpose": "LOCATION",
"city": "Eaton",
"state": "OH",
"postal_code": "453208699",
"country_code": "US",
"telephone_number": "937-456-8376",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3535 Southern Blvd",
"address_purpose": "LOCATION",
"city": "Kettering",
"state": "OH",
"postal_code": "454291221",
"country_code": "US",
"telephone_number": "937-395-8166",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "405 W Grand Ave",
"address_purpose": "LOCATION",
"city": "Dayton",
"state": "OH",
"postal_code": "454057538",
"country_code": "US",
"telephone_number": "937-723-3211",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6147 State Route 122",
"address_purpose": "LOCATION",
"city": "Middletown",
"state": "OH",
"postal_code": "450055201",
"country_code": "US",
"telephone_number": "513-261-3410",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1141 N Monroe Dr",
"address_purpose": "LOCATION",
"city": "Xenia",
"state": "OH",
"postal_code": "453851619",
"country_code": "US",
"telephone_number": "937-352-2500",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "8701 Old Troy Pike",
"address_purpose": "LOCATION",
"city": "Huber Heights",
"state": "OH",
"postal_code": "454241066",
"country_code": "US",
"telephone_number": "937-558-3338",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4000 Miamisburg Centerville Rd",
"address_purpose": "LOCATION",
"city": "Miamisburg",
"state": "OH",
"postal_code": "453427615",
"country_code": "US",
"telephone_number": "937-384-8791",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACOBS",
"first_name": "KENNETH",
"middle_name": "LEE DINE",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-13",
"last_updated": "2020-07-27",
"certification_date": "2020-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "OH",
"license": "34.005854",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0986116",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000017441",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; 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.