Michael Pescatore Jacobson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.006734RX Issued in OH

Practice address

2122 E Highland Ave Ste 335
Phoenix, AZ 85016-4760

Phone

(602) 824-8404

NPI assigned

Apr 22, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• South Community Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Moraine, OH
  • NPI 1427289818
  Medicare reassignment NPD
• Gerhard F Gomez MD LLC

  • Psychiatry Physician
  • Phoenix, AZ
  • NPI 1215474101
  NPD
• Jessica Cruz Psychiatric Services, LLC

  • Nurse Practitioner
  • Phoenix, AZ
  • NPI 1265383350
  NPD (past)

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

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750377600000",
    "number": "1700406477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 E HIGHLAND AVE STE 335",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164760",
            "telephone_number": "602-824-8404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 E HIGHLAND AVE STE 335",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164760",
            "telephone_number": "602-824-8404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "MICHAEL",
        "middle_name": "PESCATORE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-22",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.006734RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0437964",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donald Eugene Joseph Jacobson Jr.
• Douglas John Jacobson, MD
• Julia Jacobson
• Kevin Jacobson
• Michael Andrew Jacobson, D.C.
• Traci Jacobson
• Nikki Christina Jacobus
• Deborah Jacoby, FNP
• David Joseph Jacofsky, M.D.
• Simon Pedro Jacquez, PA

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.