Michael Jacob

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

4331 Issued in MN

Practice address

3400 1St St N Ste 101
Saint Cloud, MN 56303-1924

Phone

(612) 268-5858

NPI assigned

Mar 12, 2024

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

Medicare fee-for-service enrollment

Enrolled in MN

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

Mental Health Counselor

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Group practices

Affinity Psychological Services PCGroup PAC ID 0749528552, 66 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Law

State licenses

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.

• Affinity Psychological Services, P.C.

  • Mental Health Counselor
  • Edina, MN
  • NPI 1245610856
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1336907575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7401 METRO BLVD STE 250",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554393062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 1ST ST N STE 101",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031924",
            "telephone_number": "612-268-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MN",
            "license": "4331",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "4331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Jean Iverson, CRNA
• Stacy Marie Jackels
• Brianna Jamilla Jackson
• Robert Jack Jackula, OD
• Sally Beth Jackula, OD
• Gregory Jacobs, DO
• Jaclyn N Jacobs, M.D.
• Jessica Jacobs
• Rebekka Jacobs, MD
• Robert Conrad Jacobs, MD

• Mental Health Counselor in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; 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.