Active NPI
Albert Dale Jacobson, M.D.
- Pediatrics Physician
- Phoenix, AZ
National Provider Identifier
1477566982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 8698
- Practice address
- 1919 E Thomas Rd
Ambulatory Building
Phoenix, AZ 85016-7710 - Phone
- (602) 933-0945
- Fax
- (602) 933-0222
- NPI assigned
- Aug 14, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 8698 | AZ | Primary |
Addresses
Primary practice location
1919 E Thomas Rd
Ambulatory Building
Phoenix, AZ 85016-7710
Mailing address
1919 E Thomas Rd
Building 2108, Suite 101
Phoenix, AZ 85016-7710
Phone (602) 512-8029
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8698 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Children'S Hospital Hope | 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.
-
- Pharmacy
- Phoenix, AZ
- NPI 1386749836
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358812800000",
"number": "1477566982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1919 E THOMAS RD",
"address_2": "BUILDING 2108, SUITE 101",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850167710",
"telephone_number": "602-512-8029",
"fax_number": "602-512-8161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1919 E THOMAS RD",
"address_2": "AMBULATORY BUILDING",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850167710",
"telephone_number": "602-933-0945",
"fax_number": "602-933-0222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "ALBERT",
"middle_name": "DALE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2013-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AZ",
"license": "8698",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.