Randolph J Jacobs, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G61654 Issued in CA

Practice address

23905 Clinton Keith Rd Ste 114
Wildomar, CA 92595-7899

Phone

(951) 672-7673

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

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

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Hemet Valley Medical Center

  • General Acute Care Hospital
  • Hemet, CA
  • NPI 1508939349
  NPD (past)
• Menifee Valley Medical Center

  • General Acute Care Hospital
  • Sun City, CA
  • NPI 1881781482
  NPD (past)
• Uhs Corona Inc

  dba Corona Regional Medical Center

  • Rehabilitation Hospital Unit
  • Corona, CA
  • NPI 1255327920
  NPD (past)
• Universal Health Services of Rancho Springs Inc

  dba Southwest Healthcare - Inland Valley Hospital

  • General Acute Care Hospital
  • Murrieta, CA
  • NPI 1245221050
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205280000000",
    "number": "1417975905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23905 CLINTON KEITH RD STE 114",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925957899",
            "telephone_number": "951-672-7673",
            "fax_number": "951-672-1197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23905 CLINTON KEITH RD STE 114",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925957899",
            "telephone_number": "951-672-7673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "RANDOLPH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G61654",
            "primary": true
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "CA",
            "license": "G61654",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "CA",
            "license": "G61654",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "G61654",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "CA",
            "license": "G61654",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inland Valley Trauma and Acute Care Surgery Apc Inc
• Inscriptions Children's Clinic
• Tynan Ipaye
• John Ippolito, PHARMACIST
• Sarah Jacob
• Brent Jacobsen, D.O
• Bryanna Jaime
• James Hoch DDS PC
• Alyssa James
• Madalyn Jasper, DPT

• Dermatology Physician in Wildomar, CA
• Providers in Wildomar, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.