John Jacob, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

4301110446 Issued in MI

Practice address

1000 Oakland Dr
Kalamazoo, MI 49008-1282

Phone

(734) 560-6224

NPI assigned

Jun 15, 2016

Sex

Male

Sole proprietor

No

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.

• Bronson-Acadia Joint Venture, LLC

  • Psychiatric Hospital
  • Battle Creek, MI
  • NPI 1083337372

  MI

  Medicare reassignment NPD
• Kalamazoo County Community Mental Health Authority

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kalamazoo, MI
  • NPI 1710066253

  MI

  Medicare reassignment NPD
• Neuropsychology Associates PLC

  • Psychologist
  • Kalamazoo, MI
  • NPI 1447209051

  MI

  Medicare reassignment NPD
• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1235188673

  MI

  Medicare reassignment NPD
• Western Michigan University School of Medicine

  • Multi-Specialty Clinic/Center
  • Kalamazoo, MI
  • NPI 1316212343

  MI

  Medicare reassignment NPD
• Kalamazoo County Community Mental Health Authority

  • Community/Behavioral Health Agency
  • Kalamazoo, MI
  • NPI 1477225506
  NPD
• Michigan State University Kalamazoo Center for Medical Studies

  • Multi-Specialty Clinic/Center
  • Kalamazoo, MI
  • NPI 1568467249
  NPD
• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1689499667
  NPD
• Health Imperatives Inc.

  • Non-Surgical Family Planning Clinic/Center
  • New Bedford, MA
  • NPI 1013051614
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jjacob336673@epic00.shdirect.org

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 11, 2022.

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1346690948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282",
            "telephone_number": "269-337-6019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282",
            "telephone_number": "734-560-6224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-15",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MI",
            "license": "4301110446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry Jackson, M.D.
• Lluvia Ivonne Jackson, LLMSW
• Matthew Jackson, LMSW
• Peyton Jackson
• Yvonne Denise Jackson, PT
• Alexis Lynn Jacobs, BSW
• Brian Jacobs
• Lara Megan Jacobs, LLPC
• Linnea Jaconette, CRNA
• Ayaz Jaffer, RPH

• All providers in Kalamazoo, MI
• Child & Adolescent Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.