NPIMap

Individual provider Active NPI

Paul Brian Jacob, D.O.

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Oklahoma City, OK
National Provider Identifier
1548433345
Registry record updated Feb 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
5494 Issued in OK
Practice address
9800 Broadway Extension
Suite 201
Oklahoma City, OK 73114
Phone
(405) 424-5426
Fax
(405) 424-5431
NPI assigned
Apr 12, 2008
Last updated
Feb 3, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 390200000X OH
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 5494 OK Primary
Orthopedic Physical Therapist 2251X0800X OH-9638 OH

Addresses

Primary practice location

9800 Broadway Extension
Suite 201
Oklahoma City, OK 73114

Mailing address

9800 Broadway Extension
Suite 201
Oklahoma City, OK 73114
Phone (405) 424-5426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140620000954 OK Practitioner - Orthopedic Surgery 9537399035 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Ohio University, College of Osteopathic Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Physicians Group, LLCGroup PAC ID 8325950603, 107 clinicians

Practice addresses (Care Compare)

10021 S Western Ave
Oklahoma City, OK 73139-2927
Phone (405) 692-9300

1616 S Kelly Ave
Edmond, OK 73013-3651
Phone (405) 330-0032

9800 Broadway Ext
Oklahoma City, OK 73114-6304

9800 Broadway Extension
Suite 203
Oklahoma City, OK 73114-6304
Phone (405) 427-6776

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement158
Knee replacement337

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5494OKMDGeneral Practice Dentistry
OH-9638OHMDOrthopedic Physical Therapist
390200000XOHMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
The Physicians Group LLC Orthopaedic Surgery CurrentSince Jun 1, 2014 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Community Hospital LLC Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

10021 S Western Ave
Oklahoma City, OK 73139
Phone (405) 692-9300

9800 Broadway Ext
Ste 201
Oklahoma City, OK 73114
Phone (405) 419-5665

Interoperability endpoints

  • Direct secure messaging: pauljacob@okss.allscriptsdirect.net
  • Direct secure messaging: pjacob156840@direct.integrisok.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community HospitalOklahoma City, OK, CCN 370203 Hospital Corporate Director Jan 30, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1207958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454457600000",
    "number": "1548433345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9800 BROADWAY EXTENSION",
            "address_2": "SUITE 201",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73114",
            "telephone_number": "405-424-5426",
            "fax_number": "405-424-5431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9800 BROADWAY EXTENSION",
            "address_2": "SUITE 201",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73114",
            "telephone_number": "405-424-5426",
            "fax_number": "405-424-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "PAUL",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-12",
        "last_updated": "2016-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OH",
            "license": "390200000X",
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "OK",
            "license": "5494",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "OH",
            "license": "OH-9638",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.