Carolyn Yvette Jacobs, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

225602 Issued in NY

Practice address

1425 Portland Ave
Rochester, NY 14621-3001

Phone

(585) 922-2575

Fax

(585) 922-5033

NPI assigned

Jan 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cjacobs556807@direct.medicine.duke.edu

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.

• Lincoln Community Health Center Incorporated

  • Federally Qualified Health Center (FQHC)
  • Durham, NC
  • NPI 1114978582
  Medicare reassignment NPD
• Lincoln Community Health Center Incorporated

  dba Lakewood Clinic

  • Federally Qualified Health Center (FQHC)
  • Durham, NC
  • NPI 1114614518
  NPD

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

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1306825575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213001",
            "telephone_number": "585-922-2575",
            "fax_number": "585-922-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213001",
            "telephone_number": "585-922-2575",
            "fax_number": "585-922-5033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Fayetteville St",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277072398",
            "country_code": "US",
            "telephone_number": "919-956-4508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "CAROLYN",
        "middle_name": "YVETTE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-16",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "225602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02688306",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacksons Health Family Health NP
• Jacksons Transportaion Service
• Seth Christopher Jacob-Wagner, NP
• Tom Jacob, DO
• Andree Jacobs-Perkins, M.D.
• Diane Catherine Jacobs, PHD
• Elisa Ann Jacobs, OTR/L
• Isaac John Jacobs, LCSW
• Isabel Anna Jacobs, M.A., SLP
• Marie Louise Jacobs, MD

• Pediatrics Physician in Rochester, NY
• Providers in Rochester, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; 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.

Verify at the official NPI Registry.