Sera L Jacob, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

9600264 Issued in NC

Practice address

802 Green Valley Rd
Suite 106
Greensboro, NC 27408-7041

Phone

(336) 716-2255

Fax

(336) 716-9440

NPI assigned

May 23, 2006

Last updated

Nov 18, 2011By the provider in NPPES

Sex

Female

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1003803032
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321574400000",
    "number": "1598710246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 344",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271020344",
            "telephone_number": "336-716-2255",
            "fax_number": "336-716-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 GREEN VALLEY RD",
            "address_2": "SUITE 106",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087041",
            "telephone_number": "336-716-2255",
            "fax_number": "336-716-9440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "SERA",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2011-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "9600264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1197J",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891197J",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lily Diana Jackson, RN
• Michelle Jackson, FNP-BC
• Miya Jackson
• Patricia Katherine Jackson, LCMHC, NCC
• Vera Mae Jackson
• Anna Victoria Jacobs, PA
• Bret Charles Jacobs, D.O.
• Brianna Kaitlin Jacobs
• Caitlin Megan Jacobs, FNP-C
• Christopher Dewayne Jacobs

• Otolaryngology Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Otolaryngology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; 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.