Active NPI
Mary Lynn Jacobs, OT
- Occupational Therapist
- Amherst, MA
National Provider Identifier
1487739637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1391
- Practice address
- 101 University Dr
Suite a-6
Amherst, MA 01002-2473 - Phone
- (413) 366-5703
- Fax
- (413) 992-2019
- NPI assigned
- Oct 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hand Occupational Therapist | 225XH1200X | |||
| Occupational Therapist | 225X00000X | 1391 | MA | Primary |
Addresses
Primary practice location
101 University Dr
Suite a-6
Amherst, MA 01002-2473
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
Other identifiers 23
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 043527497 | Other | MA | GREATWEST |
| 11222870 | Other | CAQH | |
| 4214936 | Other | MA | AETNA-INDIV # |
| 670001710 | Other | MA | RAILROAD MEDICARE |
| 0389005 | Medicaid | MA | |
| 043527497 | Other | MA | UNITED HEALTH CARE |
| 972730 | Other | MA | NETWORK HEALTH |
| 043527497 | Other | MA | CONSOLIDATED |
| 043527497 | Other | MA | NORTH REGIONS CLAIMS |
| 9715568 | Medicaid | MA | |
| P328227 | Other | OXFORD | |
| 043527497 | Other | MA | UNICARE/GIC |
| 469635 | Other | MA | TUFTS-IND # |
| 043527 | Other | MA | CONNECTICARE |
| 103355100 | Other | MA | DEPT OF LABOR |
| 7710306 | Other | MA | CIGNA INDIV # |
| OG0011 | Other | MA | BC BS GROUP # |
| 000000035317 | Other | MA | BOSTON HEALTNET |
| 690675 | Other | MA | TUFTS |
| 043527497 | Other | MA | CIGNA |
| 043527497 | Other | MA | AETNA |
| 110001391MA02 | Other | ANTHEM | |
| OT0046 | Other | MA | BC/BS INDIV PROVIDER # |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1391 | MA | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Performance Rehabilitation of Western New England LLC | Occupational Therapist | Past | Accepting new patients |
| Performance Rehabilitation of Western New England LLC | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Hand Occupational Therapist
- Wilbraham, MA
- NPI 1083949861
-
- Occupational Therapist
- Springfield, MA
- NPI 1447445523
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493769600000",
"number": "1487739637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223",
"fax_number": "630-759-9510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 UNIVERSITY DR",
"address_2": "SUITE A-6",
"city": "AMHERST",
"state": "MA",
"postal_code": "010022473",
"telephone_number": "413-366-5703",
"fax_number": "413-992-2019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "MARY LYNN",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-26",
"last_updated": "2017-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "225XH1200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Hand",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MA",
"license": "1391",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREATWEST",
"identifier": "043527497",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11222870",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA-INDIV #",
"identifier": "4214936",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "670001710",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0389005",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "043527497",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH",
"identifier": "972730",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONSOLIDATED",
"identifier": "043527497",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORTH REGIONS CLAIMS",
"identifier": "043527497",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9715568",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P328227",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNICARE/GIC",
"identifier": "043527497",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS-IND #",
"identifier": "469635",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE",
"identifier": "043527",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR",
"identifier": "103355100",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA INDIV #",
"identifier": "7710306",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS GROUP #",
"identifier": "OG0011",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOSTON HEALTNET",
"identifier": "000000035317",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "690675",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "043527497",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "043527497",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "110001391MA02",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS INDIV PROVIDER #",
"identifier": "OT0046",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amherst, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.