Michael D Jacob, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

28181433A Issued in IN

Practice address

7150 Clearvista Drive
Indianapolis, IN 37043

Phone

(317) 621-5890

Fax

(317) 355-2205

NPI assigned

May 3, 2006

Last updated

Jul 21, 2015By 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 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IN, OH, KY3 enrollments

Enrollment records 3

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Indiana Anesthesia Associates, LLCGroup PAC ID 6709234750, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Northern Indiana Anesthesia Associates, LLC

  • Certified Registered Nurse Anesthetist
  • South Bend, IN
  • NPI 1033891510

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Anesthesia Care Associates, LLC

  • Certified Registered Nurse Anesthetist
  • South Bend, IN
  • NPI 1073899449

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Anesthesia Dynamics LLC

  • Anesthesiology Physician
  • Bradenton, FL
  • NPI 1073001012

  IN, Nurse Anesthetist, Certified Registered, OH

  Medicare reassignment NPD
• Lake Erie Sedation Associates, LLC

  • Certified Registered Nurse Anesthetist
  • Chagrin Falls, OH
  • NPI 1265927594

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Lec Ancillary PLLC

  • Certified Registered Nurse Anesthetist
  • Louisville, KY
  • NPI 1982917365

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Northstar Anesthesia of Kentucky, PLLC

  • Anesthesiology Physician
  • Louisville, KY
  • NPI 1386938900

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Southwest Ohio Anesthesia Consultants LLC

  • Anesthesiology Physician
  • Cincinnati, OH
  • NPI 1588645188

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Western Ohio Sedation Associates, LLC

  • Certified Registered Nurse Anesthetist
  • Beavercreek, OH
  • NPI 1649777699

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• U S Anesthesia Partners of Kentucky PSC

  • Anesthesiology Physician
  • Louisville, KY
  • NPI 1144901042

  Nurse Anesthetist, Certified Registered

  NPD
• Digestive Care of Evansville PC

  • Gastroenterology Physician
  • Newburgh, IN
  • NPI 1376751891
  NPD (past)
• Wabash Valley Anesthesia

  • Certified Registered Nurse Anesthetist
  • Noblesville, IN
  • NPI 1720023799

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Louisville Endoscopy Center, PLLC

  dba Louisville Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Louisville, KY
  • NPI 1003888595
  NPD (past)

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437436800000",
    "number": "1508824905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7150 CLEARVISTA DRIVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "37043",
            "telephone_number": "317-621-5890",
            "fax_number": "317-355-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2015-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "103360",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28181433A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000595410",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3628323",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200926510",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vesta Jackson
• Vincent Maurice Jackson Sr.
• Waukesha Jackson
• Cody J Jacob, MD
• James Allen Jacob, M.D.
• Seethal A Jacob, M.D.
• William Paul Jacob
• Scott Jay Jacober, D.O.
• Abigail Jacobs, RBT
• Alaina Jacobs, RBT

• Certified Registered Nurse Anesthetist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Certified Registered Nurse Anesthetist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.