Emily Jacobs, MD
Individual provider Active NPI Cornea and External Diseases Specialist Physician · Stickney, IL
NPI 1669715959 · NPPES record last updated Jun 1, 2021
Key facts
- NPI
- 1669715959
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cornea and External Diseases Specialist Physician 207WX0120X
- License
- 036152736 (IL)
- Practice address
- 4401 S Harlem Ave
Stickney, IL 60402-4250 - Phone
- (708) 788-3400
- Fax
- (708) 788-3472
- NPI assigned
- Apr 4, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Ophthalmology
- Education
- Jefferson Medical College of Thomas Jefferson University, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ronald S Weiss MD SC
Practice addresses (Care Compare)
4401 S Harlem Ave
Stickney, IL 60402-4250
Phone (708) 788-3400
Hospital & facility affiliations
- Macneal Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 56 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201222001172 | IL | Practitioner - Ophthalmology | 1456628726 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036152736 | IL | MD | Ophthalmology Physician |
| 287768-1 | NY | MD | Cornea and External Diseases Specialist Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ronald S Weiss MD SC | Ophthalmology | Current |
Accepting new patients |
| Loyola University Medical Center | Current | Accepting new patients |
Locations
4401 S Harlem Ave
Stickney, IL 60402
Phone (708) 788-3400
Interoperability endpoints
- ejacobs133456@direct.luhs.org
- ejacobs11309@nychhc.direct-ci.com
- emily.jacobs.p10@direct.hauserross.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 036152736 | IL | |
| Cornea and External Diseases Specialist Physician | 207WX0120X | 287768-1 | NY | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Cornea and External Diseases Specialist Physician | 207WX0120X | 036152736 | IL | Yes |
Addresses
Primary practice location
4401 S Harlem Ave
Stickney, IL 60402-4250
Mailing address
4401 S Harlem Ave
Stickney, IL 60402-4250
Phone (708) 788-3400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010036152736 | Medicaid | IL |
Other providers in Stickney, IL
- Janine Bednarz
- Nestor Diaz
- Kinzy Kanisha Frizzle
- Desiree Gonzalez
- Cristopher Guzman
- Tami Lynn Jimenez
- Thomas J Mack
- Daniel John Maturo
- Milan Meghpara
- Manuel E Murillo Ruiz
All providers in Stickney, IL · Cornea and External Diseases Specialist Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.