Active NPI
Mark Matthew Jacobs, M.D.
- Obstetrics & Gynecology Physician
- San Leandro, CA
National Provider Identifier
1679533186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- G45317
- Practice address
- 3553 Whipple Road
San Leandro, CA 94587-1507 - Phone
- (510) 454-1000
- Fax
- (415) 499-4213
- NPI assigned
- Mar 27, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | G45317 | CA | Primary |
| Maternal & Fetal Medicine Physician | 207VM0101X | G45317 | CA |
Addresses
Primary practice location
3553 Whipple Road
San Leandro, CA 94587-1507
Mailing address
3553 Whipple Road
Union City, CA 94587-1507
Phone (510) 454-1000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G45317 | Other | CA | CA STATE LICENSE NUMBER |
| 00G453170 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G45317 | CA | MD | Maternal & Fetal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prima Medical Group, Inc. | 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.
-
- Family Medicine Physician
- San Rafael, CA
- NPI 1154377489
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443744000000",
"number": "1679533186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3553 WHIPPLE ROAD",
"city": "UNION CITY",
"state": "CA",
"postal_code": "945871507",
"telephone_number": "510-454-1000",
"fax_number": "415-499-4213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3553 WHIPPLE ROAD",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945871507",
"telephone_number": "510-454-1000",
"fax_number": "415-499-4213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "MARK",
"middle_name": "MATTHEW",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-27",
"last_updated": "2015-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "CA",
"license": "G45317",
"primary": true
},
{
"code": "207VM0101X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
"state": "CA",
"license": "G45317",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA STATE LICENSE NUMBER",
"identifier": "G45317",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G453170",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.