NPIMap

Organization Active NPI

Hpoms

  • Oral and Maxillofacial Surgery Clinic/Center
  • Highland Park, IL
National Provider Identifier
1588070148
Registry record updated Jul 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
License
021.002059 Issued in IL
Legal business name
HPOMS
Practice address
1893 Sheridan Rd Suite 311
Highland Park, IL 60035
Phone
(847) 433-6636
Fax
(847) 433-2090
NPI assigned
Jul 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2014

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

Authorized official

Name
Dr. Mark B Jacob, DDS, MS, PCNPI 1659486751
Title
Owner
Phone
(847) 433-6636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019.022948 IL
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 021.002059 IL Primary

Addresses

Primary practice location

1893 Sheridan Rd Suite 311
Highland Park, IL 60035

Mailing address

1893 Sheridan Rd Suite 311
Highland Park, IL 60035
Phone (847) 433-6636

National Provider Directory

National Provider Directory
Tax ID family
Highland Park Oms2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1893 Sheridan Rd
Ste 311
Highland Park, IL 60035
Phone (847) 433-6636

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1404345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404345600000",
    "number": "1588070148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1893 SHERIDAN RD SUITE 311",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "60035",
            "telephone_number": "847-433-6636",
            "fax_number": "847-433-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1893 SHERIDAN RD SUITE 311",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "60035",
            "telephone_number": "847-433-6636",
            "fax_number": "847-433-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HPOMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-03",
        "last_updated": "2014-07-03",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-433-6636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS, PC"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019.022948",
            "primary": false
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021.002059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.