NPIMap

Individual provider Active NPI

Radim Jacob

  • Internal Medicine Physician
  • Orange Park, FL
National Provider Identifier
1669935128
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME155370 Issued in FL
Practice address
2001 Kingsley Ave
Orange Park, FL 32073-5156
Phone
(904) 639-2000
Fax
(904) 639-2015
NPI assigned
Apr 11, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME155370 FL Primary

Addresses

Primary practice location

2001 Kingsley Ave
Orange Park, FL 32073-5156

Mailing address

1592 Porter Lakes Dr
Jacksonville, FL 32218-9047
Phone (904) 316-4972

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20230526001564 NY Practitioner - Internal Medicine 2163759135 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Progressive Care Medical Group PLLCGroup PAC ID 7113298209, 45 clinicians

Practice addresses (Care Compare)

150 Eileen Way
Unit 1
Syosset, NY 11791-5313
Phone 5168555255109

Hospital & facility affiliations

  • Emerest Home Health Care of Ny Home health agency, Bronx, NY, CCN 337456
  • Americare Certified Special Services, Inc Chha Home health agency, Brooklyn, NY, CCN 337290
  • Tender Loving Care, an Amedisys Company Home health agency, Carle Place, NY, CCN 337143
  • Prime Home Health Services, LLC Home health agency, Brooklyn, NY, CCN 337190
  • Preferred Certified Home health agency, Mount Vernon, NY, CCN 337458
  • United Hospice Hospice, New City, NY, CCN 331522
  • The Enclave At Rye Rehab And Nursing Ctr Nursing home, Port Chester, NY, CCN 335312
  • Tolstoy Foundation Rehabilitation And Nrsg Center Nursing home, Valley Cottage, NY, CCN 335311

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Progressive Care Medical Group, PLLC Internal Medicine CurrentSince May 17, 2023 Accepting new patients
Port Chester Operating LLC Past Accepting new patients
Tolstoy Foundation Nursing Home Company Inc Past Accepting new patients

Locations

150 Eileen Way
Unit 1
Syosset, NY 11791
Phone (516) 855-5255

100 Lake Rd
Vly Cottage, NY 10989
Phone (845) 268-6813

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Enclave at Port Chester Rehabilitation and Nursing CenterPort Chester, NY, CCN 335312 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2025
Apr 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1669935128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1592 PORTER LAKES DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322189047",
            "telephone_number": "904-316-4972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735156",
            "telephone_number": "904-639-2000",
            "fax_number": "904-639-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "RADIM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-11",
        "last_updated": "2022-08-02",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME155370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.