Active NPI
Mark Jacobson, MD
- Pediatrics Physician
- Sommers Point, NJ
National Provider Identifier
1659394484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MB03043900
- Practice address
- 505 Bay Ave
Bayside Commons
Sommers Point, NJ 08244 - Phone
- (609) 927-4235
- Fax
- (609) 927-5590
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MB03043900 | NJ | Primary |
| Pediatrics Physician | 208000000X | OS-003415-L | PA |
Addresses
Primary practice location
505 Bay Ave
Bayside Commons
Sommers Point, NJ 08244
Mailing address
505 Bay Ave
Bayside Commons
Sommers Point, NJ 08244
Phone (609) 927-4235
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2261308 | Medicaid | NJ |
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)
- Not enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MB03043900 | NJ | MD | Pediatrics Physician |
| OS-003415-L | PA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chop Clinical Associates, Inc | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Somers Point, NJ
- NPI 1619057437
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659394484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 BAY AVE",
"address_2": "BAYSIDE COMMONS",
"city": "SOMMERS POINT",
"state": "NJ",
"postal_code": "08244",
"telephone_number": "609-927-4235",
"fax_number": "609-927-5590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 BAY AVE",
"address_2": "BAYSIDE COMMONS",
"city": "SOMMERS POINT",
"state": "NJ",
"postal_code": "08244",
"telephone_number": "609-927-4235",
"fax_number": "609-927-5590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "MB03043900",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "OS-003415-L",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2261308",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sommers Point, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.