Antony Thekkumpuram Jacob, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

35.058320 Issued in OH

Practice address

30 E Apple St
Ste L200
Dayton, OH 45409-2932

Phone

(937) 208-2020

Fax

(937) 208-2109

NPI assigned

Jun 17, 2005

Last updated

Aug 18, 2014By the provider in NPPES

Sex

Male

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Physical Medicine Associates Inc

  • Physical Medicine & Rehabilitation Physician
  • Dayton, OH
  • NPI 1407809783
  NPD (past)
• Premier Health Specialist Inc

  dba Premier Physical Medicine Associates

  • Physical Medicine & Rehabilitation Physician
  • Dayton, OH
  • NPI 1588935902
  NPD (past)

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408320000000",
    "number": "1609871417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E APPLE ST",
            "address_2": "STE L200",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092932",
            "telephone_number": "937-208-2020",
            "fax_number": "937-208-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E APPLE ST",
            "address_2": "STE L200",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092932",
            "telephone_number": "937-208-2020",
            "fax_number": "937-208-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "ANTONY",
        "middle_name": "THEKKUMPURAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2014-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "OH",
            "license": "35.058320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0739366",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Jackson
• Tina Jackson
• Tracey Jackson
• Tramyra Yuetrice Jackson I
• Tyleah Jackson
• Celine Jacob, D.O.
• David Andrew Jacob, PHARMD
• Melinda Beth Jacob, COTA
• Raseena Jacob
• Alan K Jacobs, MD

• Physical Medicine & Rehabilitation Physician in Dayton, OH
• Providers in Dayton, OH by specialty
• Physical Medicine & Rehabilitation Physician in Ohio

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