Individual provider Active NPI

Susan Jacob, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1306315130
Registry record updated Dec 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP139784 Issued in TX
Practice address
4645 Samuell Blvd
Dallas, TX 75228-6826
Phone
(214) 743-1200
NPI assigned
Nov 22, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP139784 TX Primary

Addresses

Primary practice location

4645 Samuell Blvd
Dallas, TX 75228-6826

Mailing address

1345 River Bend Dr Ste 200
Dallas, TX 75247-6945

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190214000132 TX Practitioner - Nurse Practitioner 3971841180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1250 W Mockingbird LN
330 Metrocare Services
Dallas, TX 75247-6949
Phone (214) 743-6159

1330 River Bend Dr
Suite 100
Dallas, TX 75247-4934
Phone (214) 743-6159

1330 River Bend Dr
Suite 300
Dallas, TX 75247-6923
Phone (214) 743-6159

1330 River Bend Dr
Suite 850
Dallas, TX 75247-4953
Phone (214) 333-7076

1345 River Bend Dr
Suite 200
Dallas, TX 75247-6945
Phone (214) 743-6159

4645 Samuell Blvd
Dallas, TX 75228-6826
Phone (214) 743-6159

4701 Samuell Blvd
Dallas, TX 75228-6828
Phone (214) 743-6159

Merit-based Incentive Payment System (MIPS)

Final score
75.31 of 100Reported as group
Quality
56.91
Promoting interoperability
52
Improvement activities
40
Cost
84.11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP139784TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dallas County Mental Health & Mental Retardation Center CurrentSince Dec 7, 2025 Accepting new patients
Dallas County Mental Health & Mental Retardation Center CurrentSince Jan 21, 2019 Accepting new patients

Locations

1380 River Bend Dr
Dallas, TX 75247
Phone (214) 743-1272

9708 Skillman St
Dallas, TX 75243
Phone (214) 221-5433

4645 Samuell Blvd
Dallas, TX 75228
Phone (214) 275-7393

1345 River Bend Dr
Ste 200
Dallas, TX 75247
Phone (214) 743-1201

1020 S Carrier Pkwy
Grand Prairie, TX 75051
Phone (214) 330-2424

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.

NPI Registry JSON

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

{
    "created_epoch": "1542844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765152000000",
    "number": "1306315130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345 RIVER BEND DR STE 200",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752476945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 SAMUELL BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752286826",
            "telephone_number": "214-743-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "SUSAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-22",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP139784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.