Bertha Elizabeth Jacobs, LCSW R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

036843 Issued in NY

Practice address

226 Randolph Street
Syracuse, NY 13205

Phone

(315) 492-6094

NPI assigned

Sep 24, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Bertha Elizabeth Bynoe Jacobs Other name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

State University of New York at Stony Brook, School of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Syracuse Jewish Family ServiceGroup PAC ID 5395905418, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Syracuse Jewish Family Service

  • Voluntary or Charitable Agency
  • Syracuse, NY
  • NPI 1649327081

  Clinical

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190592000000",
    "number": "1316133382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 RANDOLPH STREET",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13205",
            "telephone_number": "315-492-6094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 RANDOLPH STREET",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13205",
            "telephone_number": "315-492-6094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "BERTHA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "LCSW R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-24",
        "last_updated": "2007-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "036843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BERTHA",
            "last_name": "JACOBS",
            "middle_name": "ELIZABETH BYNOE",
            "credential": "LCSW R",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ralph Jackson
• Shiniece Nicole Jackson
• Theodore Jackson
• Victoria Elaine Jackson
• Joseph M Jacob, MD
• Dinah M Jacobs, CRPA
• Gary Jacobs, OD
• Adam E Jacobsen, P.A.
• Laura Jacobsen, NP
• Helen M Jacoby, MD

• Clinical Social Worker in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2007; 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.