Individual provider Active NPI

Ian N Jacobs, M.D.

  • Otolaryngology Physician
  • Philadelphia, PA
National Provider Identifier
1720178742
Registry record updated Apr 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD044440L Issued in PA
Practice address
34TH & Civic Center Blvd
The Children'S Hospital of Philadelphia
Philadelphia, PA 19104
Phone
(215) 590-3440
Fax
(215) 590-3986
NPI assigned
Oct 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD044440L PA Primary

Addresses

Primary practice location

34TH & Civic Center Blvd
The Children'S Hospital of Philadelphia
Philadelphia, PA 19104

Mailing address

100 East Penn Square
The Wanamaker Building 9TH FL
Philadelphia, PA 19107-3323
Phone (267) 425-9538

Other identifiers 1

IdentifierTypeStateIssuer
001645977MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20110110000539 PA Practitioner - Otolaryngology 7012030828 Reassigns benefits to 1 organization
I20220113001348 NJ Practitioner - Otolaryngology 7012030828 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Children'S Surgical Associates LTDGroup PAC ID 9739083494, 53 clinicians

Practice addresses (Care Compare)

3401 Civic Ctr Blvd
Philadelphia, PA 19104-4319
Phone (267) 425-9505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Surgical Associates, LTD CurrentSince Oct 3, 2022 Accepting new patients
Children'S Surgical Associates LTD Current Accepting new patients
Children'S Surgical Associates of New Jersey Inc Otolaryngology Current Accepting new patients
Children'S Surgical Associates of New Jersey Inc CurrentSince Oct 9, 2021 Accepting new patients
Children'S Surgical Associates of New Jersey Inc CurrentSince Oct 9, 2021 Accepting new patients
Radiology Associates of Children'S Hospital, Inc Past Accepting new patients
Children'S Surgical Associates LTD Otolaryngology Past Accepting new patients
Children'S Surgical Associates LTD Past Accepting new patients
Childrens Health Care Associates of New Jersey PC Past Accepting new patients

Locations

4009 Black Horse Pike
Mays Landing, NJ 08330
Phone (267) 425-9505

101 Plainsboro Rd
Plainsboro, NJ 08536
Phone (267) 425-9505

1012 Laurel Oak Rd
Voorhees, NJ 08043
Phone (856) 435-0086

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3500 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-2169

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

3401 Civic Center Blvd
Ste 34
Philadelphia, PA 19104

100 E Penn Sq
Bldg 9TH
Philadelphia, PA 19107
Phone (267) 425-9538

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365724800000",
    "number": "1720178742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 EAST PENN SQUARE",
            "address_2": "THE WANAMAKER BUILDING 9TH FL",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073323",
            "telephone_number": "267-425-9538",
            "fax_number": "267-425-9552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34TH & CIVIC CENTER BLVD",
            "address_2": "THE CHILDREN'S HOSPITAL OF PHILADELPHIA",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-590-3440",
            "fax_number": "215-590-3986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "IAN",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2013-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "PA",
            "license": "MD044440L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001645977",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.