Active NPI
Jacob Gelberg, MD
- Pulmonary Disease Physician
- Prescott, AZ
National Provider Identifier
1568180610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- 66074
- Practice address
- 1003 Willow Creek Rd
Prescott, AZ 86301-1641 - Phone
- (928) 445-2700
- NPI assigned
- Aug 16, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | 66074 | AZ | Primary |
Addresses
Primary practice location
1003 Willow Creek Rd
Prescott, AZ 86301-1641
Mailing address
1003 Willow Creek Rd
Prescott, AZ 86301-1641
Phone (928) 445-2700
Other practice location 1
1003 Willow Creek Rd
Prescott, AZ 86301-1641
Phone (928) 445-2700
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 568946544 | Other | AZ | BCBS |
| 5874 | Other | AZ | HEALTH PARTNERS |
| 236 | Medicaid | AZ |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | securerecords.sanford.html | Dignity Health |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660608000000",
"number": "1568180610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1003 WILLOW CREEK RD",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863011641",
"telephone_number": "928-445-2700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1003 WILLOW CREEK RD",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863011641",
"telephone_number": "928-445-2700"
}
],
"practiceLocations": [
{
"address_1": "1003 Willow Creek Rd",
"address_purpose": "LOCATION",
"city": "Prescott",
"state": "AZ",
"postal_code": "863011641",
"country_code": "US",
"telephone_number": "928-445-2700",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GELBERG",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-08-16",
"last_updated": "2022-08-16",
"certification_date": "2022-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "AZ",
"license": "66074",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "568946544",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "5874",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "236",
"state": "AZ"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "securerecords.sanford.html",
"affiliation": "Y",
"affiliationName": "Dignity Health",
"address_1": "1003 Willow Creek Rd",
"city": "Prescott",
"state": "AZ",
"country_code": "US",
"postal_code": "863011641",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.