NPIMap

Individual provider Active NPI

Prema M Jacob, MD

  • Family Medicine Physician
  • Loveland, CO
National Provider Identifier
1487633533
Registry record updated Nov 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
43958 Issued in CO
Practice address
3850 Grant Ave
Suite 100
Loveland, CO 80538-8431
Phone
(970) 776-1862
Fax
(970) 482-9646
NPI assigned
Jan 16, 2006
Last updated
Nov 25, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MA04062800 NJ
Family Medicine Physician 207Q00000X 43958 CO Primary

Addresses

Primary practice location

3850 Grant Ave
Suite 100
Loveland, CO 80538-8431

Mailing address

4674 Snow Mesa Drive
Suite 140
Fort Collins, CO 80528
Phone (970) 225-5010

Other identifiers 1

IdentifierTypeStateIssuer
18905072MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060227000500 CO Practitioner - Family Practice 9234195215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Physical Therapy of West Denver Limited PartnershipGroup PAC ID 6709771157, shared by 5 NPIs, 530 clinicians
Bender Medical Group IncGroup PAC ID 6204725575, 7 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

2964 Ginnala Dr
Loveland, CO 80538-2701
Phone (970) 667-7755

313 W Drake Rd
Suite 100
Fort Collins, CO 80526-2866
Phone (970) 482-8881

4674 Snow Mesa Dr
Suite 140
Fort Collins, CO 80528-8614
Phone (970) 225-5107

730 14TH St SW
Loveland, CO 80537-6349
Phone (970) 663-0815

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions88
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
43958COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bender Medical Group Inc Family Medicine CurrentSince Dec 24, 2013 Accepting new patients
Family Physical Therapy Center, P.C. Past Accepting new patients
Big Thompson Medical Group Inc Family Medicine Past Accepting new patients

Locations

313 W Drake Rd
Ste 100
Fort Collins, CO 80526
Phone (970) 225-5028

4674 Snow Mesa Dr
Ste 140
Fort Collins, CO 80528
Phone (970) 225-5000

3850 Grant Ave
Ste 100
Loveland, CO 80538
Phone (970) 669-5717

Organizations & group practices 3

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.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448409600000",
    "number": "1487633533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4674 SNOW MESA DRIVE",
            "address_2": "SUITE 140",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80528",
            "telephone_number": "970-225-5010",
            "fax_number": "970-482-9646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 GRANT AVE",
            "address_2": "SUITE 100",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805388431",
            "telephone_number": "970-776-1862",
            "fax_number": "970-482-9646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "PREMA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-16",
        "last_updated": "2015-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA04062800",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "43958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18905072",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.