Individual provider Active NPI

Ann Marie Jacobs, ANP

  • Adult Health Nurse Practitioner
  • North Tonawanda, NY
National Provider Identifier
1699235580
Registry record updated Mar 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F308803-1 Issued in NY
Practice address
445 Tremont St
North Tonawanda, NY 14120-6150
Phone
(716) 690-2410
NPI assigned
Mar 25, 2019
Last updated
Mar 25, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F308803-1 NY Primary

Addresses

Primary practice location

445 Tremont St
North Tonawanda, NY 14120-6150

Mailing address

256 Siegfried Dr
Williamsville, NY 14221-4458
Phone (716) 632-2980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190610001341 NY Practitioner - Nurse Practitioner 7618200452 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
308803NYMDDermatology Physician
F308803-1NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kaleida Health CurrentSince May 1, 2019 Accepting new patients
Kaleida Health Current Accepting new patients
Kaleida Health CurrentSince May 1, 2019 Accepting new patients

Locations

900 Hertel Ave
Buffalo, NY 14216
Phone (716) 871-1571

445 Tremont St
North Tonawanda, NY 14120
Phone (716) 690-2291

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1553472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1699235580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 SIEGFRIED DR",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142214458",
            "telephone_number": "716-632-2980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 TREMONT ST",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141206150",
            "telephone_number": "716-690-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "ANN MARIE",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-25",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F308803-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Tonawanda, NY

Sources for this page

Verify at the official NPI Registry.