Individual provider Active NPI

Michael Todd Jacobs, M.D.

  • Diagnostic Radiology Physician
  • Hickory, NC
National Provider Identifier
1659482040
Registry record updated Feb 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
200100384 Issued in NC
Practice address
18 13TH Ave NE
Hickory, NC 28601-3748
Phone
(828) 322-2644
Fax
(828) 327-2235
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2012

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

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X 200100384 NC
Neuroradiology Physician 2085N0700X 200100384 NC
Nuclear Radiology Physician 2085N0904X 200100384 NC
Pediatric Radiology Physician 2085P0229X 200100384 NC
Diagnostic Radiology Physician 2085R0202X 200100384 NC Primary
Therapeutic Radiology Physician 2085R0203X 200100384 NC
Vascular & Interventional Radiology Physician 2085R0204X 200100384 NC
Radiological Physics Physician 2085R0205X 200100384 NC
Diagnostic Ultrasound Physician 2085U0001X 200100384 NC

Addresses

Primary practice location

18 13TH Ave NE
Hickory, NC 28601-3748

Mailing address

PO Box 308
Hickory, NC 28603-0308
Phone (828) 322-2644

Other identifiers 7

IdentifierTypeStateIssuer
129G7OtherNCBCBS
560941927OtherNCMEDCOST
300132080OtherNCRAILROAD MEDICARE
89129G7MedicaidNC
560941927OtherNCUNITED HEALTHCARE
246190OtherNCMAMSI
560941927OtherNCCIGNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20051228000764 NC Practitioner - Diagnostic Radiology 4082636451 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200100384NCMDDiagnostic Ultrasound Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Catawba Radiological Associates, Inc. Body Imaging CurrentSince Jul 8, 2002 Accepting new patients

Locations

18 13th Ave NE
Hickory, NC 28601
Phone (828) 322-2644

Interoperability endpoints

  • Direct secure messaging: tjacobs107825@direct.unc.nchie.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330473600000",
    "number": "1659482040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 308",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286030308",
            "telephone_number": "828-322-2644",
            "fax_number": "828-327-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 13TH AVE NE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286013748",
            "telephone_number": "828-322-2644",
            "fax_number": "828-327-2235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "MICHAEL",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "NC",
            "license": "200100384",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "NC",
            "license": "200100384",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "NC",
            "license": "200100384",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "NC",
            "license": "200100384",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "200100384",
            "primary": true
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "NC",
            "license": "200100384",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NC",
            "license": "200100384",
            "primary": false
        },
        {
            "code": "2085R0205X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiological Physics",
            "state": "NC",
            "license": "200100384",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "NC",
            "license": "200100384",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "129G7",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "560941927",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300132080",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89129G7",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "560941927",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "246190",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "560941927",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

Verify at the official NPI Registry.