Active NPI
Michael A Jacobs, PA-C
- Physician Assistant
- Kenosha, WI
National Provider Identifier
1700993227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1170-023
- Practice address
- 10400 75TH St
Kenosha, WI 53142-7884 - Phone
- (262) 948-7080
- Fax
- (262) 948-7328
- NPI assigned
- Aug 23, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1170-023 | WI | Primary |
Addresses
Primary practice location
10400 75TH St
Kenosha, WI 53142-7884
Mailing address
PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42987800 | Medicaid | WI |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mjacobs47654@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056
10400 75TH St
Kenosha, WI 53142-7884
Phone (262) 948-7000
Hospital & facility affiliations
- Aurora at Home
- Aurora Medical Center Kenosha
- Jupiter Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1170-023 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aurora Medical Group, Inc. | Current | Accepting new patients | |
| Aurora Medical Group, Inc. | Past | Accepting new patients |
Locations
10400 75th St
Kenosha, WI 53142
Phone (262) 697-7000
1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056
Interoperability endpoints
- mjacobs47654@direct.myadvocateaurora.org
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.
-
- Certified Registered Nurse Anesthetist
- Milwaukee, WI
- NPI 1427271378
-
- Durable Medical Equipment & Medical Supplies
- Manitowoc, WI
- NPI 1801941075
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Kenosha, WI
- NPI 1225156888
-
- Home Health Agency
- West Allis, WI
- NPI 1134255037
-
- General Acute Care Hospital
- Jupiter, FL
- NPI 1295721090
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757980800000",
"number": "1700993227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 735044",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606735044",
"telephone_number": "800-326-2250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10400 75TH ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531427884",
"telephone_number": "262-948-7080",
"fax_number": "262-948-7328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "MICHAEL",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2025-09-16",
"certification_date": "2025-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "1170-023",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42987800",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mjacobs47654@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "10400 75th St",
"city": "Kenosha",
"state": "WI",
"country_code": "US",
"postal_code": "531427884",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "10400 75th St",
"city": "Kenosha",
"state": "WI",
"country_code": "US",
"postal_code": "531427884",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.