Mark David Jacobson, M.D.

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

ME67158 Issued in FL

Practice address

769 Highway 466
Lady Lake, FL 32159-6340

Phone

(352) 261-5502

Fax

(352) 350-5942

NPI assigned

May 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Diagnostic RadiologyAlso: Interventional Radiology

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Imaging and Therapeutics LLCGroup PAC ID 5597901603, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Medical Imaging & Therapeutics LLC

  • Diagnostic Radiology Physician
  • Lady Lake, FL
  • NPI 1528308350
  Medicare reassignment Care Compare group Authorized official
• Inverness Medical Imaging LLC

  • Diagnostic Radiology Physician
  • Inverness, FL
  • NPI 1093763591
  Medicare reassignment
• Nature Coast Anesthesia Providers, P.a.

  • Certified Registered Nurse Anesthetist
  • Mount Dora, FL
  • NPI 1578557104
  NPD (past)
• Radcare of Florida LLC

  • Diagnostic Radiology Physician
  • Spring Hill, FL
  • NPI 1508000704
  NPD (past)
• Radiology Associates of Central Florida L L C

  dba Lake Medical Imaging

  • Diagnostic Radiology Physician
  • Leesburg, FL
  • NPI 1184689127
  NPD (past)
• FSH Radiology Inc

  • Diagnostic Radiology Physician
  • Beachwood, OH
  • NPI 1588869929
  NPD (past)
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573516800000",
    "number": "1306894423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "922 SHORE ACRES DR",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347489269",
            "telephone_number": "352-261-5502",
            "fax_number": "352-261-5504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "769 HIGHWAY 466",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321596340",
            "telephone_number": "352-261-5502",
            "fax_number": "352-350-5942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2019-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME67158",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "FL",
            "license": "ME67158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "376466400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vatsal Inamdar, MD
• Innovative Therapies Group Inc
• Intercommunity Cancer Center - Lady Lake Campus LLC
• J. Michael Whitt DMD PA
• Tiffany Jack, HIS
• Hemwattie S Jaimangal, DO
• Jane Johansson, APRN
• John Cottam MD PA
• Johnny Gurgen DO PA
• Gina Nicole Johnson, ARNP

• Vascular & Interventional Radiology Physician in Lady Lake, FL
• Providers in Lady Lake, FL by specialty
• Vascular & Interventional Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.