NPIMap

Individual provider Active NPI

Jason Sanford Jacob, MD

  • Diagnostic Radiology Physician
  • Tacoma, WA
National Provider Identifier
1417033051
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD00047516 Issued in WA
Practice address
1304 Fawcett Ave Ste 100
Tacoma, WA 98402
Phone
(253) 761-4200
Fax
(253) 761-4201
NPI assigned
Oct 27, 2006
Last updated
Aug 30, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Radiology Physician 2085N0904X MD00047516 WA
Diagnostic Radiology Physician 2085R0202X MD00047516 WA Primary

Addresses

Primary practice location

1304 Fawcett Ave Ste 100
Tacoma, WA 98402

Mailing address

PO Box 1535
Tacoma, WA 98401-1535
Phone (253) 761-4200

Other identifiers 4

IdentifierTypeStateIssuer
0345133OtherWALABOR & INDUSTRY-TRA
0230054OtherWALABOR & INDUSTRY-UNION AVE
0230052OtherWALABOR & INDUSTRY-TRA KING COUNTY
1054847MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080326000855 WA Practitioner - Diagnostic RadiologyPractitioner - Nuclear Medicine 7416050315 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Nuclear Medicine
Education
Washington University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tra-Minw P SGroup PAC ID 2163316167, 152 clinicians

Practice addresses (Care Compare)

1304 Fawcett Ave
Suite 100
Tacoma, WA 98402-1905

1515 Dock St
Unit 223
Tacoma, WA 98402-3254
Phone (251) 761-4200

16251 Sylvester Rd SW
Burien, WA 98166-3017
Phone (253) 841-4353

222 15TH Ave SE
Puyallup, WA 98372-3754
Phone (253) 841-4353

2502 S Union Ave
Tacoma, WA 98405-1328
Phone (253) 841-4353

3402 S 18TH St
Tacoma, WA 98405-1903
Phone (253) 841-4353

34515 9TH Ave S
Federal Way, WA 98003-6761
Phone (253) 841-4353

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Mar 1, 2017 Accepting new patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Mar 1, 2017 Accepting new patients
Tra Medical Imaging Centers LLC CurrentSince Dec 1, 2025 Accepting new patients
Union Avenue Open MRI LLC CurrentSince Mar 23, 2014 Accepting new patients
New York University Medical Center Faculty Practice Radiology Diagnostic Radiology PastSince Oct 1, 1997 Accepting new patients
Tra-Minw P S Past Accepting new patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance Past Accepting new patients
Nyumc Radiology Associates Diagnostic Radiology PastSince Oct 1, 1997 Accepting new patients

Locations

122 3rd St NE
Auburn, WA 98002
Phone (253) 833-7750

21110 Sr 410 E
Ste 110
Bonney Lake, WA 98391

5900 State Highway 303 NE
Bremerton, WA 98311
Phone (253) 459-6633

4700 Point Fosdick Dr
Ste 110
Gig Harbor, WA 98335
Phone (253) 759-2622

500 Lilly Rd NE
Ste 160
Olympia, WA 98506
Phone (360) 413-8307

11212 Sunrise Blvd E
Ste 200
Puyallup, WA 98374

222 15th Ave SE
Puyallup, WA 98372

3400 California Ave SW
Seattle, WA 98116
Phone (206) 320-3399

1304 Fawcett Ave
Ste 100
Tacoma, WA 98402
Phone (253) 680-3372

1624 S I St
Ste 405
Tacoma, WA 98405
Phone (253) 274-4545

1724 West Union Ave
Ste 100
Tacoma, WA 98405
Phone (253) 830-5200

2502 S Union Ave
Tacoma, WA 98405
Phone (253) 759-5900

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

3402 S 18th St
Tacoma, WA 98405
Phone (253) 383-1099

5919 100th St SW
Tacoma, WA 98499

9601 Steilacoom Blvd SW
Tacoma, WA 98498
Phone (253) 582-8900

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ei-trami

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1417033051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1535",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984011535",
            "telephone_number": "253-761-4200",
            "fax_number": "253-383-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 FAWCETT AVE STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98402",
            "telephone_number": "253-761-4200",
            "fax_number": "253-761-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JASON",
        "middle_name": "SANFORD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "WA",
            "license": "MD00047516",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD00047516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRY-TRA",
            "identifier": "0345133",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRY-UNION AVE",
            "identifier": "0230054",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRY-TRA KING COUNTY",
            "identifier": "0230052",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1054847",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.