Active NPI
Edward Jacobson, M.D.
- Specialist
- Greenwich, CT
National Provider Identifier
1336208651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 22707
- Practice address
- 1 Perryridge Rd
Greenwich, CT 06830-4607 - Phone
- (203) 869-8353
- Fax
- (203) 869-4004
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 22707 | CT | Primary |
Addresses
Primary practice location
1 Perryridge Rd
Greenwich, CT 06830-4607
Mailing address
1 Perryridge Rd
Greenwich, CT 06830-4607
Phone (203) 869-8353
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010022707CT02 | Other | CT | BLUE CROSS PROVIDER NUMBE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 1, 2014 through Mar 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22707 | CT | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1336208651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 PERRYRIDGE RD",
"city": "GREENWICH",
"state": "CT",
"postal_code": "068304607",
"telephone_number": "203-869-8353",
"fax_number": "203-869-4004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 PERRYRIDGE RD",
"city": "GREENWICH",
"state": "CT",
"postal_code": "068304607",
"telephone_number": "203-869-8353",
"fax_number": "203-869-4004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CT",
"license": "22707",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER NUMBE",
"identifier": "010022707CT02",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenwich, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.