Active NPI
Shannon Jacobs
- Registered Dietitian
- Edina, MN
National Provider Identifier
1528893906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 3250 W 66TH St Unit 55
Edina, MN 55435-2522 - Phone
- (651) 447-6737
- NPI assigned
- Sep 4, 2024
- Last updated
- Sep 4, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
3250 W 66TH St Unit 55
Edina, MN 55435-2522
Mailing address
8063 N Arcata Dr
Tucson, AZ 85743-1182
Phone (423) 914-0434
Other practice location 1
8063 N Arcata Dr
Tucson, AZ 85743-1182
Phone (423) 914-0434
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 8, 2022 through Dec 8, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725408000000",
"number": "1528893906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8063 N ARCATA DR",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857431182",
"telephone_number": "423-914-0434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3250 W 66TH ST UNIT 55",
"city": "EDINA",
"state": "MN",
"postal_code": "554352522",
"telephone_number": "651-447-6737"
}
],
"practiceLocations": [
{
"address_1": "8063 N Arcata Dr",
"address_purpose": "LOCATION",
"city": "Tucson",
"state": "AZ",
"postal_code": "857431182",
"country_code": "US",
"telephone_number": "423-914-0434",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACOBS",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-04",
"last_updated": "2024-09-04",
"certification_date": "2024-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.