Evan L Jacobson, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

D0061839 Issued in MD

Practice address

3801 Pga Blvd
Palm Beach Gardens, FL 33410-2758

Phone

(561) 815-9791

Fax

(561) 972-7283

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2012 through Oct 1, 2026

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 and National Provider Directory roles.

• Ejmd, PLLC

  • Psychiatry Physician
  • Palm Beach Gardens, FL
  • NPI 1356039317
  NPD Authorized official

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1629010665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 PGA BLVD",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334102758",
            "telephone_number": "561-815-9791",
            "fax_number": "561-972-7283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 PGA BLVD",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334102758",
            "telephone_number": "561-815-9791",
            "fax_number": "561-972-7283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "EVAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "150265",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101236570",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D0061839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Meister Jackson, PHARMD
• Crystal Louise Jackson, MSN, APRN, WHNP-BC
• Natasha Monique Jackson, DPT
• Michael A Jacobs, MD PA
• Tara Jacobs, NP-C
• Michelle C Jacobson, LCSW
• Andrew Todd Jaffe, M.D.
• Diane Jane Jagoda, MSW
• Ragena Montana Lisa Jagon
• James C Dee DMD

• Psychiatry Physician in Palm Beach Gardens, FL
• Providers in Palm Beach Gardens, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.