Annamma J Jacob, M.D.

Primary specialty

Allergy PhysicianTaxonomy code 207KA0200X

License

0101034078 Issued in VA

Practice address

1635 N George Mason Dr
Ste 240
Arlington, VA 22205-3681

Phone

(703) 528-1329

Fax

(703) 522-4915

NPI assigned

Jul 27, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Thomas N Jacob MD PC

  • Psychiatry Physician
  • Arlington, VA
  • NPI 1689127797
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493164800000",
    "number": "1386668903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 N GEORGE MASON DR",
            "address_2": "STE 240",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222053681",
            "telephone_number": "703-528-1329",
            "fax_number": "703-522-4915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 N GEORGE MASON DR",
            "address_2": "STE 240",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222053681",
            "telephone_number": "703-528-1329",
            "fax_number": "703-522-4915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "ANNAMMA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2017-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "VA",
            "license": "0101034078",
            "primary": true
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "VA",
            "license": "0101034078",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "081723",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60-4923-1",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "54-1272326",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M.D.I.P.A",
            "identifier": "29164",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE CROSS BLUE",
            "identifier": "8803",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Faunice Rebecca Jackson, DPT, P.T.
• Irene Shetzline Jackson, M.A. CCCSLP
• Kaitlyn Jackson, DNAP, CRNA
• Takiya Nachelle Jackson, M.ED
• Terrina Jackson
• Katherine Sessoms Jacobi, LCSW
• Jacobs Chiropractic LLC
• Alana Kerwin Jacobs, PSY.D
• Brian Daniel Jacobs, LPC
• Janie Jacobs

• Allergy Physician in Arlington, VA
• Providers in Arlington, VA by specialty
• Allergy Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2017; 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.