Madeleine Jacobs, M.D. – Family Medicine Physician

Key facts

NPI: 1306811575
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: 27100 (CO)
Practice address: 91 Illinois Ave
Penrose, CO 81240-9683
Phone: (719) 372-6555
Fax: (719) 372-6559
NPI assigned: Feb 21, 2006
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

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.

Penrose Family Health Clinic Family Medicine Physician · Penrose, CO · NPI 1578910790

NPD (past) FAMILY MEDICINE

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

Practice roles

Organization	Specialty	Status	New patients
Penrose Family Health Clinic	Family Medicine	Past since Jun 1, 1987	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	27100	CO	Yes

Addresses

Primary practice location

91 Illinois Ave
Penrose, CO 81240-9683

Mailing address

91 Illinois Ave
Penrose, CO 81240-9683
Phone (719) 372-6555

Other identifiers

Identifier	Type	State	Issuer
01271006	Medicaid	CO

Other providers in Penrose, CO

All providers in Penrose, CO · Family Medicine Physician in Colorado

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.