Individual provider Active NPI

Reza Jacob, M.D.

  • Dermatology Physician
  • La Jolla, CA
National Provider Identifier
1407084908
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A118826 Issued in CA
Practice address
10820 N Torrey Pines Rd
La Jolla, CA 92037-1036
Phone
(858) 554-8645
NPI assigned
Jun 24, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A118826 CA Primary

Addresses

Primary practice location

10820 N Torrey Pines Rd
La Jolla, CA 92037-1036

Mailing address

10790 Rancho Bernardo Rd
San Diego, CA 92127-5705
Phone (858) 554-8645

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20120517000679 CA Practitioner - Dermatology 6406019009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of California, San Diego School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

10820 N Torrey Pines Rd
La Jolla, CA 92037-1036
Phone (858) 554-4100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision97
Removal of tissue33
Removal of skin lesions2572
Removal of nail tissue1-10
Removal or shaving of skin growth413
Skin biopsy128

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A118826CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Current Accepting new patients
Scripps Health Dermatology CurrentSince Jun 20, 2016 Accepting new patients
Scripps Health CurrentSince Jun 20, 2016 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health Current Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients
Scripps Health Past Accepting new patients
Scripps Health Past Accepting new patients

Locations

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

10820 N Torrey Pines Rd
La Jolla, CA 92037
Phone (858) 554-3300

File 54433
Los Angeles, CA 90074
Phone (858) 784-5645

3965 5th Ave
Ste 200
San Diego, CA 92103
Phone (619) 542-0013

2445 Truxtun Rd
Ste 200
San Diego, CA 92106
Phone (619) 272-5200

10790 Rancho Bernardo Rd
San Diego, CA 92127
Phone (858) 554-2626

Interoperability endpoints

  • Direct secure messaging: rjacob10107@scrippshlth.medalliesdirect.net

Organizations & group practices 8

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1407084908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10790 RANCHO BERNARDO RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921275705",
            "telephone_number": "858-554-8645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10820 N TORREY PINES RD",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371036",
            "telephone_number": "858-554-8645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "REZA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A118826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.