Kenneth Michael Jacob, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

R3D70 Issued in MO

Practice address

19460 Caladesi Dr
Fort Myers, FL 33967-5572

Phone

(913) 707-0826

NPI assigned

Feb 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Diagnostic Radiology

Education

University of Kansas School of Med (KC/Wich/Sal), 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Curators of the University of MissouriGroup PAC ID 4486759560, 1,108 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Missouri Health Care Hospital, Columbia, MO, CCN 260141

Merit-based Incentive Payment System (MIPS)

Final score

80.23 of 100Reported as group

Quality

58.17

Promoting interoperability

100

Improvement activities

40

Cost

75.92

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• The Curators of the University of Missouri

  • Multi-Specialty Clinic/Center
  • Columbia, MO
  • NPI 1235126921
  Medicare reassignment Care Compare group NPD
• Curators of the University of Missouri

  dba University Physicians Specialty Care Associates

  • Durable Medical Equipment & Medical Supplies
  • Columbia, MO
  • NPI 1356963201
  NPD
• Alliance Radiology, PA

  • Diagnostic Radiology Physician
  • Shawnee Mission, KS
  • NPI 1467400663
  NPD (past)

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

• Curators of the University of Missouri

  dba Capital Region Medical Center

  • General Acute Care Hospital
  • Jefferson City, MO
  • NPI 1174597892
  Care Compare affiliation
• Curators of the University of Missouri

  dba University of Missouri Health Care

  • General Acute Care Hospital
  • Columbia, MO
  • NPI 1699769901
  Care Compare affiliation

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384300800000",
    "number": "1437121829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19460 CALADESI DR",
            "address_2": "APT/SUITE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339675572",
            "telephone_number": "913-707-0826",
            "fax_number": "417-772-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19460 CALADESI DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339675572",
            "telephone_number": "913-707-0826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "KENNETH",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2013-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "R3D70",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100154570D",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "12485021",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203728035",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lee Douglas Jackson, NP-C
• Monserrat Guerrero Jackson
• Peggy Ann Jackson, L.C.S.W.
• Renuka Jackson
• William T Jackson
• Sha'Nariyah Jacob, RBT
• Allen T Jacobs, MD
• Bruce Paul Jacobs, RPH
• Darren R Jacobs, D.O.
• Randall S Jacobs, MD

• Diagnostic Radiology Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Diagnostic Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; 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.