Adam L Jacobson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

126159 Issued in MA

Practice address

220 Reservoir St Ste 21
Needham, MA 02494-3133

Phone

(781) 429-7754

NPI assigned

Mar 20, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• County of San Mateo

  • Adolescent and Children Mental Health Clinic/Center
  • San Bruno, CA
  • NPI 1215029087
  NPD (past)
• County of San Mateo

  • Community/Behavioral Health Agency
  • Redwood City, CA
  • NPI 1528432481
  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684368000000",
    "number": "1487779096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 RESERVOIR ST STE 21",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024943133",
            "telephone_number": "781-429-7754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 RESERVOIR ST STE 21",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024943133",
            "telephone_number": "781-429-7754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "ADAM",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2023-05-18",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS23743",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "126159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4141 Geary Blvd",
            "city": "San Francisco",
            "state": "CA",
            "country_code": "US",
            "postal_code": "941183109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anthony Haig Jackson, MD
• Deborah S. Jacobs, M.D.
• Jerry Jacobs, LICSW
• Mark D. Jacobs, MD
• Renee M Jacobs, M.D.
• Lisa Jacobson, OD
• Pragati Jaiswal, MA, ET
• Meagan Jameson
• Jay L. Cohen, MD, PC
• Sharmilee Jayachandran, N.D.

• All providers in Needham, MA
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.