Active NPI
Gregory T Jacobs, DO
- Emergency Medicine Physician
- Evansville, IN
National Provider Identifier
1467485607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 02003898A
- Practice address
- 600 Mary St
Evansville, IN 47710-1674 - Phone
- (812) 450-3405
- Fax
- (812) 450-3099
- NPI assigned
- Jul 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 10648 | MT | |
| Emergency Medicine Physician | 207P00000X | 02003898A | IN | Primary |
| Emergency Medicine Physician | 207P00000X | 02993 | KY |
Addresses
Primary practice location
600 Mary St
Evansville, IN 47710-1674
Mailing address
PO Box 3407
Evansville, IN 47733-3407
Phone (812) 450-3405
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200844060 | Medicaid | IN | |
| 64127962 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10648 | MT | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Physicians Group PSC | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Owensboro, KY
- NPI 1184639742
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411689600000",
"number": "1467485607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3407",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477333407",
"telephone_number": "812-450-3405",
"fax_number": "812-450-3099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 MARY ST",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477101674",
"telephone_number": "812-450-3405",
"fax_number": "812-450-3099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "GREGORY",
"middle_name": "T",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-09",
"last_updated": "2014-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MT",
"license": "10648",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IN",
"license": "02003898A",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "KY",
"license": "02993",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200844060",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64127962",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.