Russell F Jacoby, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

32200 Issued in WI

Practice address

3108 Ponte Morino Drive
Palmer Professional Centre Suite 230
Cameron Park, CA 95682-5022

Phone

(530) 672-2701

Fax

(530) 672-9097

NPI assigned

Feb 27, 2006

Last updated

Feb 4, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• California Gastroenterology, a Medical Corporation

  • Gastroenterology Physician
  • Cameron Park, CA
  • NPI 1578736138
  Authorized official Same address or phone
• Maury Regional Hospital Marshall Medical Center

  dba Marshall Medical Center

  • Critical Access Hospital
  • Lewisburg, TN
  • NPI 1578591756
  NPD (past)

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202083200000",
    "number": "1700852878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3108 PONTE MORINO DRIVE",
            "address_2": "PALMER PROFESSIONAL CENTRE SUITE 230",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956825022",
            "telephone_number": "530-672-2701",
            "fax_number": "530-672-9097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3108 PONTE MORINO DRIVE",
            "address_2": "PALMER PROFESSIONAL CENTRE SUITE 230",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956825022",
            "telephone_number": "530-672-2701",
            "fax_number": "530-672-9097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBY",
        "first_name": "RUSSELL",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2008-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WI",
            "license": "32200",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "G86695",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "36071501",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31708100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Innovative Treatment Associates Inc
• Lianne Chiemi Inouye, O.D.
• Kristopher T. Isaacs, P.T.
• Jackson Chiropractic Inc
• Garrell Keithe Jackson, DC
• Nahvid Jafarnejad, DMD
• Miranda Jiminez
• Ying Jin, RPH
• John E. Roe, PH.D., a Professional Corporation
• John Kelada M.D., Inc.

• Gastroenterology Physician in Cameron Park, CA
• Providers in Cameron Park, CA by specialty
• Gastroenterology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.