Mark B Jacob

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

021.002059 Issued in IL

Practice address

1893 Sheridan Rd Ste 311
Highland Park, IL 60035-2646

Phone

(847) 433-6636

Fax

(847) 433-2090

NPI assigned

Aug 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2011 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Highland Park Oms

  • Oral and Maxillofacial Surgery (Dentist)
  • Highland Park, IL
  • NPI 1912283730
  NPD (past) Authorized official
• Hpoms

  • Oral and Maxillofacial Surgery Clinic/Center
  • Highland Park, IL
  • NPI 1588070148
  NPD (past) Authorized official
• The Board of Trustees of the University of Illinois

  • Occupational Medicine Physician
  • Chicago, IL
  • NPI 1043727571
  NPD (past)

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1659486751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 S MARSHFIELD AVE",
            "address_2": "9TH FLOOR (M/C 732)",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124305",
            "telephone_number": "312-996-7699",
            "fax_number": "312-996-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1893 SHERIDAN RD STE 311",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600352646",
            "telephone_number": "847-433-6636",
            "fax_number": "847-433-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "MARK",
        "middle_name": "B",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "IL",
            "license": "021.002059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ira L Shapira Dental Sleep Medicine LTD
• Sadeka Jamil Ismail
• Susan Iverson, OTRL
• Lauren K Jacker
• Alishia Jacks
• Marcy Ann Jacobs, M.S.W., L.C.S.W.
• Jacqueline G Rosen
• Roshni Jain, MD
• Mart Jalakas, MD
• James E. Schuetz M.D. LTD.

• Oral & Maxillofacial Surgery (D.M.D.) in Highland Park, IL
• Providers in Highland Park, IL by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.