Jacobson Ma, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DN 21765 Issued in FL

Practice address

40545 US Highway 19 N Ste G
Tarpon Springs, FL 34689

Phone

(727) 626-2119

NPI assigned

Apr 6, 2015

Last updated

Sep 3, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• Freedom Health HMO Network

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

{
    "created_epoch": "1428278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535932800000",
    "number": "1497140412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 OAKDALE LN S",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337646459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40545 US HIGHWAY 19 N STE G",
            "city": "TARPON SPRINGS",
            "state": "FL",
            "postal_code": "34689",
            "telephone_number": "727-626-2119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4030 Park Blvd N",
            "address_purpose": "LOCATION",
            "city": "Pinellas Park",
            "state": "FL",
            "postal_code": "337813633",
            "country_code": "US",
            "telephone_number": "727-213-5765",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MA",
        "first_name": "JACOBSON",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-06",
        "last_updated": "2018-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN 21765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Lugo, BCBA
• Charles Lwin, PTA
• Jolanta M M Kuczek, PHARMD
• M.Fernanda Therapy PLLC
• M&M Health Holdings (Mind and Mobility)
• George Patrick Macris, MD
• Logan Magoulis
• James Matthew Maister, R.PH.
• Michael R. Marcell I, D.C.
• Jessica Leigh Marchand

• Dentist in Tarpon Springs, FL
• Providers in Tarpon Springs, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2018; 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.