J. Bruce Jacobs, M.D., Inc.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

A21604 Issued in CA

Legal business name

J. BRUCE JACOBS, M.D., INC.

Practice address

1821 W Olive Ave
Burbank, CA 91506-2435

Phone

(818) 841-8880

Fax

(818) 841-8884

NPI assigned

Apr 24, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Alexander Usmanov, M.D.

Title

President

Phone

(818) 841-8880

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CALIFORNIA RADIOLOGY .COM Doing business as

Locations

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

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390780800000",
    "number": "1316205644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 W OLIVE AVE",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915062435",
            "telephone_number": "818-841-8880",
            "fax_number": "818-841-8884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 W OLIVE AVE",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915062435",
            "telephone_number": "818-841-8880",
            "fax_number": "818-841-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. BRUCE JACOBS, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-24",
        "last_updated": "2014-01-27",
        "status": "A",
        "authorized_official_last_name": "USMANOV",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-841-8880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A21604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316205644",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CALIFORNIA RADIOLOGY .COM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Diagnostic Radiology Physician in Burbank, CA
• Providers in Burbank, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.