Active NPI
Scott Neil Jacobson, MD
- Family Medicine Physician
- Henderson, NV
National Provider Identifier
1366658965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 13465
- Practice address
- 10120 S Eastern Ave Ste 130
Henderson, NV 89052 - Phone
- (702) 970-1111
- Fax
- (702) 688-4373
- NPI assigned
- May 14, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 13465 | NV | Primary |
Addresses
Primary practice location
10120 S Eastern Ave Ste 130
Henderson, NV 89052
Mailing address
10120 S Eastern Ave Ste 130
Henderson, NV 89052-3953
Phone (702) 970-1111
Other practice location 1
3012 S Durango Dr
Suite 1
Las Vegas, NV 89117-9186
Phone (702) 366-0640
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5315026203 | Other | MI | CONTROLLED SUBST LICENSE |
| 4301087602 | Other | MI | ED LIMITED LICENSE |
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 Jan 29, 2018 through Jan 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531699200000",
"number": "1366658965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10120 S EASTERN AVE STE 130",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890523953",
"telephone_number": "702-970-1111",
"fax_number": "702-688-4373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10120 S EASTERN AVE STE 130",
"city": "HENDERSON",
"state": "NV",
"postal_code": "89052",
"telephone_number": "702-970-1111",
"fax_number": "702-688-4373"
}
],
"practiceLocations": [
{
"address_1": "3012 S Durango Dr",
"address_2": "Suite 1",
"address_purpose": "LOCATION",
"city": "Las Vegas",
"state": "NV",
"postal_code": "891179186",
"country_code": "US",
"telephone_number": "702-366-0640",
"fax_number": "702-366-9075",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACOBSON",
"first_name": "SCOTT",
"middle_name": "NEIL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-14",
"last_updated": "2018-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NV",
"license": "13465",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONTROLLED SUBST LICENSE",
"identifier": "5315026203",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ED LIMITED LICENSE",
"identifier": "4301087602",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2018; 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.