Individual provider Active NPI

Jeffrey A. Jacob, P.T.

  • Physical Therapist
  • Fenton, MI
National Provider Identifier
1356528293
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501006259 Issued in MI
Practice address
400 Rounds Dr
Fenton, MI 48430-1724
Phone
(810) 750-1996
Fax
(810) 750-6361
NPI assigned
Jan 23, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501006259 MI Primary

Addresses

Primary practice location

400 Rounds Dr
Fenton, MI 48430-1724

Mailing address

PO Box 412031
Boston, MA 02241-2031
Phone (914) 294-4050

Other practice location 1

50505 Schoenherr Rd Ste 210
Shelby Twp, MI 48315-3140
Phone (586) 884-6689

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080222000516 MI Practitioner - Physical Therapist in Private Practice 8224112685 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Michigan LLCGroup PAC ID 6901165893, 156 clinicians

Practice addresses (Care Compare)

6575 Belding Rd NE
Suite B
Rockford, MI 49341-7417
Phone (616) 317-8048

Merit-based Incentive Payment System (MIPS)

Final score
85.78 of 100Reported as group
Quality
89.5
Improvement activities
40
Cost
71.87

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Rehabilitation Specialists of Fowlerville LLC Physical Therapist CurrentSince Jul 19, 2023 Accepting new patients
Ivyrehab Michigan, LLC Physical Therapist CurrentSince Nov 22, 2024 Accepting new patients
Michigan Rehabilitation Specialists of Fowlerville, LLC CurrentSince Jul 19, 2023 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

5700 Jackson Rd
Ann Arbor, MI 48103
Phone (734) 926-4710

16071 15 Mile Rd
Clinton Township, MI 48035
Phone (586) 981-1086

10078 Lapeer Rd
Ste B
Davison, MI 48423
Phone (810) 653-6200

23330 Farmington Rd
Farmington, MI 48336

400 Rounds Dr
Fenton, MI 48430
Phone (810) 629-0530

11407 S Saginaw St
Grand Blanc, MI 48439
Phone (810) 242-6588

3699 S Baldwin Rd
Lake Orion, MI 48359
Phone (248) 997-5990

319 S Bridge St
Linden, MI 48451
Phone (810) 735-0010

135 S Milford Rd
Ste 307
Milford, MI 48381

135 S Milford Rd
Milford, MI 48381
Phone (248) 685-7272

1764 S Ortonville Rd
Ste 400
Ortonville, MI 48462
Phone (248) 793-5730

1764 S Ortonville Rd
Ortonville, MI 48462
Phone (248) 793-5730

3856 S Rochester Rd
Rochester Hills, MI 48307
Phone (248) 233-4944

6575 Belding Rd NE
Ste B
Rockford, MI 49341
Phone (616) 317-8048

1350 Kirts Blvd
Ste 120
Troy, MI 48084
Phone (248) 244-7927

5210 Highland Rd
Ste 100
Waterford, MI 48327
Phone (248) 674-9560

8158 Cooley Lake Rd
White Lake, MI 48386
Phone (248) 956-1894

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1356528293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412031",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022412031",
            "telephone_number": "914-294-4050",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ROUNDS DR",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484301724",
            "telephone_number": "810-750-1996",
            "fax_number": "810-750-6361"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50505 Schoenherr Rd Ste 210",
            "address_purpose": "LOCATION",
            "city": "Shelby Twp",
            "state": "MI",
            "postal_code": "483153140",
            "country_code": "US",
            "telephone_number": "586-884-6689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JEFFREY",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-23",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501006259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.