Carla Jacob

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R248512 Issued in MD

Practice address

22 S Greene St
Baltimore, MD 21201-1544

Phone

(347) 268-4390

NPI assigned

Sep 16, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, MD, DC3 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MNR Industries, LLCGroup PAC ID 7416908843, 142 clinicians

University of Maryland Emergency Medicine Associates PAGroup PAC ID 1951294941, 57 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Maryland Medical Center Hospital, Baltimore, MD, CCN 210002

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cjacob976100@direct.umm.edu

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.

• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bel Air, MD
  • NPI 1457478703

  Single Specialty

  Medicare reassignment Care Compare group NPD
• University of Maryland Emergency Medicine Associates, PA

  • Emergency Medicine Physician
  • Baltimore, MD
  • NPI 1144271743

  Single Specialty

  Medicare reassignment Care Compare group NPD
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bowie, MD
  • NPI 1093130924

  DC, Single Specialty

  Medicare reassignment NPD
• University of Maryland Midtown Health Inc

  • Urgent Care Clinic/Center
  • Baltimore, MD
  • NPI 1710347729

  Single Specialty

  Medicare reassignment NPD
• Expert Medical Services LLC

  • Legal Medicine
  • New York, NY
  • NPI 1215019377

  Single Specialty

  Medicare reassignment NPD
• Fpa Hospital Based

  • Nuclear Medicine Physician
  • New York, NY
  • NPI 1629319413

  Single Specialty

  Medicare reassignment NPD
• MNR Industries LLC

  • Urgent Care Clinic/Center
  • Mount Airy, MD
  • NPI 1073963146

  Single Specialty

  NPD
• MNR Industries LLC

  • Urgent Care Clinic/Center
  • Baltimore, MD
  • NPI 1306241617
  NPD
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bel Air, MD
  • NPI 1649089418
  NPD
• Fpa Hospital Based

  • Emergency Medicine Physician
  • New York, NY
  • NPI 1427398676

  Single Specialty

  NPD
• Fpa Hospital Based

  • Dermatopathology (Pathology) Physician
  • New York, NY
  • NPI 1841531795

  Single Specialty

  NPD
• Expert Mobile Health

  • Emergency Medicine Physician
  • Floral Park, NY
  • NPI 1770284226
  NPD (past)

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

• University of Maryland Medical Center, LLC

  • General Acute Care Hospital
  • Baltimore, MD
  • NPI 1174660120
  Care Compare affiliation

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1497063010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "347-268-4390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "347-268-4390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "CARLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-16",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "NY",
            "license": "542089",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "340624",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R248512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tysheka Jackson
• Vandelle Dianne Jackson, PHARMD
• Vera Lorraine Jackson
• Waynyell Jackson, LCSW-C
• Jacksons Jubilee LLC
• Fadi Paul Jacob
• Priyanka Jacob
• Andrea Jacobs
• Ashley Jacobs
• Cosmo Gordon Jacobs, MD

• Family Nurse Practitioner in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.