Individual provider Active NPI

Sandhya Jacob, MD

  • Diagnostic Radiology Physician
  • Tacoma, WA
National Provider Identifier
1619395100
Registry record updated Jul 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD60949842 Issued in WA
Practice address
1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900
Phone
(253) 761-4200
Fax
(253) 761-4201
NPI assigned
Apr 1, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD60949842 WA Primary

Addresses

Primary practice location

1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900

Mailing address

PO Box 1535
Tacoma, WA 98401-1535
Phone (253) 761-4200

Other identifiers 5

IdentifierTypeStateIssuer
0422789OtherWAL&I-TRA-KING
0422792OtherWAL&I-DIAGNOSTIC IMAGING NW
2133414MedicaidWA
0422785OtherWAL&I-TRA-REST OF WA
0422790OtherWAL&I-UNION AVENUE OPEN MRI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200512001422 WA Practitioner - Diagnostic Radiology 9032409099 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tra-Minw P SGroup PAC ID 2163316167, 152 clinicians
Union Avenue Open MRI LLCGroup PAC ID 5597652917, 44 clinicians

Practice addresses (Care Compare)

2502 S Union Ave
Tacoma, WA 98405-1328
Phone (253) 841-4353

423 NE Maple Leaf PL
Seattle, WA 98115-5317
Phone (253) 841-4353

Hospital & facility affiliations

  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129
  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
  • St Anthony Hospital Hospital, Gig Harbor, WA, CCN 500151
  • St Francis Community Hospital Hospital, Federal Way, WA, CCN 500141
  • Multicare Good Samaritan Hospital Hospital, Puyallup, WA, CCN 500079

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60949842WAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Jul 1, 2020 Accepting new patients
Proliance Surgeons Inc P S CurrentSince Jan 7, 2022 Accepting new patients
Proliance Surgeons Inc P S Current Accepting new patients
Tra Medical Imaging Centers LLC CurrentSince Dec 1, 2025 Accepting new patients
Proliance Surgeons, Inc., P.S. Diagnostic Radiology CurrentSince Jan 7, 2022 Accepting new patients
Union Avenue Open MRI LLC CurrentSince Jul 1, 2020 Accepting new patients

Locations

510 8th Ave NE
Ste 200
Issaquah, WA 98029
Phone (425) 392-3030

222 15th Ave SE
Puyallup, WA 98372

1101 Madison St
Ste 580
Seattle, WA 98104
Phone (206) 400-7625

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

2502 S Union Ave
Tacoma, WA 98405
Phone (253) 759-5900

1304 Fawcett Ave
Ste 100
Tacoma, WA 98402
Phone (253) 680-3372

3402 S 18th St
Tacoma, WA 98405
Phone (253) 383-1099

9601 Steilacoom Blvd SW
Tacoma, WA 98498
Phone (253) 582-8900

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ei-trami
  • Direct secure messaging: sandhya.jacobs.p42@direct.proliance.nextgenshare.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1396310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1619395100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1535",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984011535",
            "telephone_number": "253-761-4200",
            "fax_number": "253-383-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 FAWCETT AVE STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984021900",
            "telephone_number": "253-761-4200",
            "fax_number": "253-761-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "SANDHYA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-01",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD60949842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I-TRA-KING",
            "identifier": "0422789",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I-DIAGNOSTIC IMAGING NW",
            "identifier": "0422792",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2133414",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I-TRA-REST OF WA",
            "identifier": "0422785",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I-UNION AVENUE OPEN MRI",
            "identifier": "0422790",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.