Jacob Blum, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME60766 Issued in FL

Practice address

1888 S 14TH St
Credentialing Department
Fernandina Beach, FL 32034-3054

Phone

(904) 261-0922

Fax

(904) 277-8872

NPI assigned

Mar 23, 2006

Last updated

Dec 31, 2018By the provider in NPPES

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 FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Corporate Health Care PSC

  dba Lyndon Family Medicine PSC

  • Adult Medicine Physician
  • Louisville, KY
  • NPI 1831397579
  NPD (past) Authorized official
• Baptist Primary Care Inc

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1508817529
  NPD (past)
• Health Psychology Associates, PSC

  • Health Psychologist
  • Louisville, KY
  • NPI 1376775668
  NPD (past)
• James Patrick Murphy MD PSC

  dba Murphy Pain Center

  • Specialist
  • Jeffersonville, IN
  • NPI 1760593115
  NPD (past)

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546214400000",
    "number": "1720047137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45443",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841450443",
            "telephone_number": "904-202-1032",
            "fax_number": "904-376-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1888 S 14TH ST",
            "address_2": "CREDENTIALING DEPARTMENT",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320343054",
            "telephone_number": "904-261-0922",
            "fax_number": "904-277-8872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUM",
        "first_name": "JACOB",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2018-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "28306",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME60766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01374253",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bio-Medical Applications of Florida, Inc. (Fresenius Kidney Care Amelia Island Dialysis)
• Anna Rene' Morris Blackshear, LMHC
• Jeffrey W Blake, MD
• William Stephen Bledsoe, PHARMD
• April Faizonia Blue-Moseley
• Danielle Susanne Blumer, RN, IBCLC
• Kwabena Boateng, PHARM.D.
• Marybeth Borreca
• Rene K Botsoe
• Barton Bott, MH

• Family Medicine Physician in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2018; 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.