NPIMap

Organization Active NPI

Jacobs & Modaber MDS, LTD.

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1750454302
Registry record updated Jan 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
JACOBS & MODABER MDS, LTD.
Practice address
2870 S Maryland Pkwy
Suite 300
Las Vegas, NV 89109-5031
Phone
(702) 735-0258
Fax
(702) 216-0216
NPI assigned
Nov 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2010

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

Authorized official

Name
Linda A Esposito
Title
Practice Administrator
Phone
(702) 735-0258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2870 S Maryland Pkwy
Suite 300
Las Vegas, NV 89109-5031

Mailing address

2870 S Maryland Pkwy
Suite 300
Las Vegas, NV 89109-5031
Phone (702) 735-0258

Other identifiers 3

IdentifierTypeStateIssuer
100502996MedicaidNV
26479OtherNVBCROSS-BSHIELD GRP#
NV7045OtherNVFEDERAL BXBS GRP#

National Provider Directory

National Provider Directory

Locations

2950 S Rainbow Blvd
Ste 240
Las Vegas, NV 89146
Phone (702) 248-3654

2870 S Maryland Pkwy
Ste 300
Las Vegas, NV 89109
Phone (702) 702-2002

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264636800000",
    "number": "1750454302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2870 S MARYLAND PKWY",
            "address_2": "SUITE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891095031",
            "telephone_number": "702-735-0258",
            "fax_number": "702-216-0216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2870 S MARYLAND PKWY",
            "address_2": "SUITE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891095031",
            "telephone_number": "702-735-0258",
            "fax_number": "702-216-0216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOBS & MODABER MDS, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2010-01-28",
        "status": "A",
        "authorized_official_last_name": "ESPOSITO",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "702-735-0258"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100502996",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCROSS-BSHIELD GRP#",
            "identifier": "26479",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BXBS GRP#",
            "identifier": "NV7045",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.