Bryan Jacobs, DMD, MS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

019.029615 Issued in IL

Practice address

4905 Old Orchard Ctr Ste 728
Skokie, IL 60077-4734

Phone

(847) 676-1432

NPI assigned

Sep 5, 2013

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

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: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 3, 2016 through Apr 3, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Dental Professionals of Old Orchard LTD

  • Customized Equipment (DME)
  • Skokie, IL
  • NPI 1710653225
  NPD (past)
• Dental Professionals of Old Orchard LTD

  • Customized Equipment (DME)
  • Chicago, IL
  • NPI 1992468128
  NPD (past)

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

{
    "created_epoch": "1378339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378339200000",
    "number": "1386079689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 E WACKER DR UNIT 4112",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606015274",
            "telephone_number": "734-276-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 OLD ORCHARD CTR STE 728",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600774734",
            "telephone_number": "847-676-1432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-05",
        "last_updated": "2013-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "IL",
            "license": "019.029615",
            "primary": true
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "MI",
            "license": "2901020269",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Loni Itah, LCPC
• Nonye Iwuh
• Chinwe Izuakor
• Constantin Izvanariu, D.D.S.
• Jan Jacher
• Rhea Jacobson, P.T.
• Alexandra Jacoby, NP
• Ann M Jacott, P.T.
• Dhanpal H Jain
• Vandana Jain, MD

• Prosthodontics in Skokie, IL
• Providers in Skokie, IL by specialty
• Prosthodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; 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.

Verify at the official NPI Registry.