Michael A Jacobson, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD434064 Issued in PA

Practice address

1051 Long Ridge Rd
Stamford, CT 06903-4436

Phone

(203) 329-7960

Fax

(203) 329-7920

NPI assigned

Oct 19, 2006

Last updated

Jan 18, 2017By 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 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, CT2 enrollments

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 2

Specialty

Micrographic Dermatologic Surgery (MDS)Also: Dermatology

Education

Jefferson Medical College of Thomas Jefferson University, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Long Ridge Dermatology LLCGroup PAC ID 4183625957, 3 clinicians

Cindy Hoffman DO PCGroup PAC ID 6608979513, 8 clinicians

Advanced Dermcare PCGroup PAC ID 8628043924, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Stamford Hospital Hospital, Stamford, CT, CCN 070006
• Danbury Hospital Hospital, Danbury, CT, CCN 070033

Merit-based Incentive Payment System (MIPS)

Final score

95.15 of 100Reported as group

Quality

87.88

Improvement activities

40

Cost

100

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mjacobson.mohs@advderm.emadirect.md

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.

• Advanced Dermcare PC

  • Dermatology Physician
  • Danbury, CT
  • NPI 1023068087
  Medicare reassignment Care Compare group NPD
• Long Ridge Dermatology,LLC

  • Specialist
  • Stamford, CT
  • NPI 1326100553
  Medicare reassignment Care Compare group NPD
• Cindy Hoffman DO PC

  • Dermatology Physician
  • Yorktown Heights, NY
  • NPI 1841284528
  Medicare reassignment Care Compare group NPD
• Skincare Physicians of Fairfield County, LLC

  • Specialist
  • Stratford, CT
  • NPI 1770531832
  Medicare reassignment NPD
• BB Medical and Dermatology Inc

  dba BB medical and dermatology

  • MOHS-Micrographic Surgery Physician
  • New York, NY
  • NPI 1790210516
  Medicare reassignment NPD
• Advanced Dermatology of New Jersey PC

  • Procedural Dermatology Physician
  • Ridgewood, NJ
  • NPI 1225362783
  NPD (past)
• Long Island Skin Cancer & Dermatologic Surgery, PC

  • Procedural Dermatology Physician
  • Smithtown, NY
  • NPI 1851595094
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Danbury Hospital

  • Dental Clinic/Center
  • Danbury, CT
  • NPI 1003835935

  Hospital

  Care Compare affiliation
• Danbury Hospital

  • General Acute Care Hospital
  • Danbury, CT
  • NPI 1548293343
  Care Compare affiliation
• Stamford Hospital

  • General Acute Care Hospital
  • Stamford, CT
  • NPI 1356331425
  Care Compare affiliation

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1649352964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 LONG RIDGE RD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069034436",
            "telephone_number": "203-329-7960",
            "fax_number": "203-329-7920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 LONG RIDGE RD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069034436",
            "telephone_number": "203-329-7960",
            "fax_number": "203-329-7920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SC",
            "license": "LL27743",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD434064",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CT",
            "license": "047462",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NY",
            "license": "260244-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack V. Diteodoro M.D,LLC
• Christopher Michael Jackson, PCC
• Lenora Jackson, NP
• Terence Stewart Jackson, DMD MA
• Jasmine V Jacob, PHARMD
• Ruthann Jaffe Birnbaum, LCSW
• Merrill B Jaffe, M.D.
• Sanjida Jahan
• Julie Jahoda, OTR/L
• Shilpi Jain-Aggarwal, MD

• Dermatology Physician in Stamford, CT
• Providers in Stamford, CT by specialty
• Dermatology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.