NPIMap

Individual provider Active NPI

Paul Anders Jacobson, M.D.

  • Orthopaedic Hand Surgery Physician
  • Traverse City, MI
National Provider Identifier
1629074190
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
License
4301076134 Issued in MI
Practice address
701 W Front St
Suite 100
Traverse City, MI 49684-2236
Phone
(231) 935-0800
Fax
(231) 935-0808
NPI assigned
Jun 21, 2005
Last updated
Oct 22, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Hand Surgery Physician 207XS0106X 4301076134 MI Primary

Addresses

Primary practice location

701 W Front St
Suite 100
Traverse City, MI 49684-2236

Mailing address

701 W Front St
Suite 100
Traverse City, MI 49684-2236
Phone (231) 935-0800

Other identifiers 2

IdentifierTypeStateIssuer
4212842MedicaidMI
0B81023OtherMIBCBSM

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address paul.jacobson@hsnmi.eclinicalworksdirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301076134MIMDOrthopaedic Hand Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Michigan Surgery Center LLC PastSince Jul 1, 2005 Accepting new patients
Hand Surgery of Northern Michigan PLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1629074190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W FRONT ST",
            "address_2": "SUITE 100",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842236",
            "telephone_number": "231-935-0800",
            "fax_number": "231-935-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W FRONT ST",
            "address_2": "SUITE 100",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842236",
            "telephone_number": "231-935-0800",
            "fax_number": "231-935-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "PAUL",
        "middle_name": "ANDERS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "MI",
            "license": "4301076134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4212842",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0B81023",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "paul.jacobson@hsnmi.eclinicalworksdirectplus.com",
            "affiliation": "N",
            "address_1": "701 W Front St",
            "address_2": "Suite 100",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496842236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; 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.