Organization Active NPI

Michael a Jacobs MD PA

  • Urology Physician
  • Palm Beach Gardens, FL
National Provider Identifier
1467727990
Registry record updated Mar 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
ME66801 Issued in FL
Legal business name
MICHAEL A JACOBS MD PA
Practice address
3370 Burns Rd
Suite 101
Palm Beach Gardens, FL 33410-4327
Phone
(561) 624-9797
Fax
(561) 624-0416
NPI assigned
Mar 16, 2012
Last updated
Mar 16, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2012

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

Authorized official

Name
Michael Alvon JacobsNPI 1619950169
Title
Physician President
Phone
(561) 624-9797

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
Urology Physician 208800000X ME66801 FL Primary

Addresses

Primary practice location

3370 Burns Rd
Suite 101
Palm Beach Gardens, FL 33410-4327

Mailing address

3370 Burns Rd
Suite101
Palm Beach Gardens, FL 33410-4327
Phone (561) 624-9797

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120319000752 FL Part B Supplier - Clinic/Group Practice 3274793898 Receives reassigned benefits from 3 practitioners
Practice locations: Palm Beach Gardens, FL

National Provider Directory

National Provider Directory

Locations

3370 Burns Rd
Ste 101
Palm Beach Gardens, FL 33410
Phone (561) 624-9797

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331856000000",
    "number": "1467727990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3370 BURNS RD",
            "address_2": "SUITE101",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104327",
            "telephone_number": "561-624-9797",
            "fax_number": "561-624-0416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3370 BURNS RD",
            "address_2": "SUITE 101",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104327",
            "telephone_number": "561-624-9797",
            "fax_number": "561-624-0416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL A JACOBS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-16",
        "last_updated": "2012-03-16",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ALVON",
        "authorized_official_title_or_position": "PHYSICIAN PRESIDENT",
        "authorized_official_telephone_number": "561-624-9797"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "ME66801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Beach Gardens, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; 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.