Barry T Jacobs, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

4283-15 Issued in WI

Practice address

615 Lake Shore Dr W
Ashland, WI 54806-1507

Phone

(715) 682-2811

NPI assigned

Dec 28, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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

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.

• Lakeview Dental Center, SC

  • General Practice Dentistry
  • Ashland, WI
  • NPI 1134285075

  General Practice

  NPD (past) Authorized official

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1508922428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 LAKE SHORE DR W",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548061507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 LAKE SHORE DR W",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548061507",
            "telephone_number": "715-682-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "BARRY",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2023-03-07",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "4283-15",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33709000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Impact Counseling Services, LLC
• Amy L Innes, PHARMD.
• John Douglas Ipsen
• Bradley C Irwin, MD
• J & C Stock SC
• Amy Jacobson, AUD
• Michaelene Pheifer Jansen, RN, CNP
• Jacey Leann Janz Vernoski
• Kristine Marie Jensch, CAC.
• Jessica Ann Joanis, MSW

• All providers in Ashland, WI
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.