Active NPI
Doris A Jacobs, PA-C
- Medical Physician Assistant
- Grand Rapids, MI
National Provider Identifier
1679795355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- DJ004588
- Practice address
- 235 Wealthy St SE
Grand Rapids, MI 49503-5247 - Phone
- (616) 840-8719
- Fax
- (616) 840-9637
- NPI assigned
- May 3, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | DJ004588 | MI | Primary |
Addresses
Primary practice location
235 Wealthy St SE
Grand Rapids, MI 49503-5247
Mailing address
235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone (616) 840-8719
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DJ004588 | MI | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mary Free Bed Rehabilitation Hospital | Past | Accepting new patients | |
| Metro Physiatry PC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Physical Medicine & Rehabilitation Physician
- Grand Rapids, MI
- NPI 1053641589
-
- Physical Medicine & Rehabilitation Physician
- Southfield, MI
- NPI 1942359666
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484092800000",
"number": "1679795355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "235 WEALTHY ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495035247",
"telephone_number": "616-840-8719",
"fax_number": "616-840-9637"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 WEALTHY ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495035247",
"telephone_number": "616-840-8719",
"fax_number": "616-840-9637"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "DORIS",
"middle_name": "A",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-03",
"last_updated": "2017-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MI",
"license": "DJ004588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.