NPIMap

Individual provider Active NPI

Richard Albert Jacob, PA-C

  • Surgical Physician Assistant
  • West Columbia, SC
National Provider Identifier
1720530934
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
2671 Issued in SC
Practice address
2728 Sunset Blvd Ste 400
West Columbia, SC 29169-4839
Phone
(803) 936-7095
Fax
(803) 936-7908
NPI assigned
Nov 4, 2016
Last updated
Nov 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 2671 SC Primary

Addresses

Primary practice location

2728 Sunset Blvd Ste 400
West Columbia, SC 29169-4839

Mailing address

PO Box 6069
West Columbia, SC 29171-6069

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rjacob55419@direct.lexmed.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170124001670 SC Practitioner - Physician Assistant 6800178013 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1013 Lake Murray Blvd
Irmo, SC 29063-2824
Phone (803) 256-4107

109 Park Place CT
Lexington, SC 29072-6690
Phone (803) 256-4107

1910 Blanding St
Columbia, SC 29201-3520
Phone (803) 256-4107

720 Rabon Rd
Columbia, SC 29203-8900
Phone (803) 256-4107

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2671SCMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Midlands Orthopaedics and Neurosurgery, PA CurrentSince Dec 1, 2022 Accepting new patients
Midlands Orthopaedics and Neurosurgery PA CurrentSince Dec 1, 2022 Accepting new patients
Lexington Health, Inc CurrentSince Feb 1, 2021 Accepting new patients
Lexington Health Inc CurrentSince Feb 1, 2021 Accepting new patients
Lexington Medical Center Past Accepting new patients

Locations

1910 Blanding St
Columbia, SC 29201
Phone (803) 253-6721

811 W Main St
Ste 101
Lexington, SC 29072
Phone (803) 936-7230

2720 Sunset Blvd
West Columbia, SC 29169
Phone (803) 791-2480

2728 Sunset Blvd
Ste 400
West Columbia, SC 29169
Phone (803) 936-7095

Interoperability endpoints

  • Direct secure messaging: richard.jacob.1@5499.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1720530934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6069",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291716069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2728 SUNSET BLVD STE 400",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291694839",
            "telephone_number": "803-936-7095",
            "fax_number": "803-936-7908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "RICHARD",
        "middle_name": "ALBERT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-04",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "2671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rjacob55419@direct.lexmed.com",
            "affiliation": "N",
            "address_1": "2728 Sunset Blvd Ste 400",
            "city": "West Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "291694839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Columbia, SC

Sources for this page

Verify at the official NPI Registry.