NPIMap

Individual provider Active NPI

Mary Anne Jacob, MD

  • Obstetrics & Gynecology Physician
  • Edina, MN
National Provider Identifier
1659348399
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
41934 Issued in MN
Practice address
6545 France Avenue South
Suite 540
Edina, MN 55435
Phone
(952) 927-4045
Fax
(952) 924-4133
NPI assigned
Mar 1, 2006
Last updated
Apr 4, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 41934 MN Primary
Reproductive Endocrinology Physician 207VE0102X 41934 MN

Addresses

Primary practice location

6545 France Avenue South
Suite 540
Edina, MN 55435

Mailing address

6545 France Avenue South
Suite 540
Edina, MN 55435
Phone (952) 927-4045

Other identifiers 3

IdentifierTypeStateIssuer
11D21JAOtherMNBLUE CROSS/BLUE SHIELD
252025700MedicaidMN
HP29251OtherMNHEALTH PARTNERS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100408000100 MN Practitioner - Obstetrics/Gynecology 3274425608 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Cincinnati College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

3111 124TH Ave NW
Suite 200
Coon Rapids, MN 55433-4573
Phone (763) 427-7300

6565 France Ave S
Suite 200
Edina, MN 55435-2141
Phone (952) 806-0011

6565 France Ave S
Suite 300
Edina, MN 55435-2154
Phone (952) 223-2100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA Obstetrics & Gynecology CurrentSince Jan 1, 2020 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Jan 1, 2020 Accepting new patients
Obstetrics and Gynecology Associates, P.a. Obstetrics & Gynecology CurrentSince Jul 1, 2011 Accepting new patients
Adefris & Toppin Women's Specialists,MDPC Obstetrics & Gynecology Past Accepting new patients
Diamond Women's Center, P.a. Obstetrics & Gynecology Past Accepting new patients

Locations

305 E Nicollet Blvd
Ste 170
Burnsville, MN 55337
Phone (952) 435-4190

6565 France Ave S
Ste 200
Minneapolis, MN 55435
Phone (952) 806-0011

6565 France Ave S
Ste 300
Minneapolis, MN 55435
Phone (952) 223-2100

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

Organizations & group practices 5

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.

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459728000000",
    "number": "1659348399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6545 FRANCE AVENUE SOUTH",
            "address_2": "SUITE 540",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-927-4045",
            "fax_number": "952-924-4133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6545 FRANCE AVENUE SOUTH",
            "address_2": "SUITE 540",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-927-4045",
            "fax_number": "952-924-4133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "MARY",
        "middle_name": "ANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-01",
        "last_updated": "2016-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "41934",
            "primary": true
        },
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "MN",
            "license": "41934",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "11D21JA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252025700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP29251",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.