NPIMap

Organization Active NPI

Jacobs Mental Health Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Clackamas, OR
National Provider Identifier
1407573850
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
JACOBS MENTAL HEALTH SERVICES
Practice address
13568 SE 97TH Ave Ste 202
Clackamas, OR 97015-6668
Phone
(503) 694-3381
NPI assigned
Oct 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Authorized official

Name
Madeline Jacobs, PMHNPNPI 1447622477
Title
Owner
Phone
(503) 694-3381

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

13568 SE 97TH Ave Ste 202
Clackamas, OR 97015-6668

Mailing address

PO Box 23993
Tigard, OR 97281-3993
Phone (612) 210-6965

Other identifiers 2

IdentifierTypeStateIssuer
1447622477OtherNPI 1
1407573850OtherGROUP NPI

Other names 1

  • Skycloud Mental Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240918002801 OR Part B Supplier - Clinic/Group Practice 0749721702 Receives reassigned benefits from 9 practitioners
Practice locations: Clackamas, OR
O20250814004685 UT Part B Supplier - Clinic/Group Practice 0749721702 Receives reassigned benefits from 1 practitioner
Practice locations: Layton, UT; West Jordan, UT

National Provider Directory

National Provider Directory

Locations

13568 SE 97th Ave
Ste 202
Clackamas, OR 97015
Phone (503) 694-3381

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1666742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726531200000",
    "number": "1407573850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23993",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972813993",
            "telephone_number": "612-210-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13568 SE 97TH AVE STE 202",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156668",
            "telephone_number": "503-694-3381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOBS MENTAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-26",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "MADELINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-694-3381",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI 1",
            "identifier": "1447622477",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1407573850",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skycloud Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Skycloud Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clackamas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.