Active NPI
Sam Jacubowitz, MD
- Emergency Medicine Physician
- Greensboro, NC
National Provider Identifier
1720043508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 93-00161
- Practice address
- 1200 N Elm St
Greensboro, NC 27401-1004 - Phone
- (336) 716-2255
- NPI assigned
- Apr 18, 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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 93-00161 | NC | Primary |
Addresses
Primary practice location
1200 N Elm St
Greensboro, NC 27401-1004
Mailing address
PO Box 602598
Wake Forest University Health Sciences
Charlotte, NC 28260-2598
Phone (336) 716-2255
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 45709 | Other | NC | NC BLUE CROSS BLUE SHIELD |
| 39-01968 | Other | NC | UHC |
| 4419 | Other | NC | PARTNERS |
| 8945709 | Medicaid | NC |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 93-00161 | NC | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wake Forest University Health Sciences | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinic/Center
- Greensboro, NC
- NPI 1194964379
Emergency Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315526400000",
"number": "1720043508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 602598",
"address_2": "WAKE FOREST UNIVERSITY HEALTH SCIENCES",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282602598",
"telephone_number": "336-716-2255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 N ELM ST",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274011004",
"telephone_number": "336-716-2255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACUBOWITZ",
"first_name": "SAM",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-18",
"last_updated": "2011-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NC",
"license": "93-00161",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC BLUE CROSS BLUE SHIELD",
"identifier": "45709",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "39-01968",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARTNERS",
"identifier": "4419",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8945709",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.