NPIMap

Individual provider Active NPI

Yacob Yousif Habboush, MD

  • Internal Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1750842142
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME156957 Issued in FL
Practice address
3625 University Blvd S
Jacksonville, FL 32216-4207
Phone
(904) 702-6111
NPI assigned
Mar 27, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X ME156957 FL Primary

Addresses

Primary practice location

3625 University Blvd S
Jacksonville, FL 32216-4207

Mailing address

3625 University Blvd S
Jacksonville, FL 32216-4207
Phone (904) 702-6111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20221003001135 FL Practitioner - Internal Medicine 7719214626 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kopa LLCGroup PAC ID 5193774461, 40 clinicians
First Coast Surgical Associates Inc.Group PAC ID 5395779359, 31 clinicians

Practice addresses (Care Compare)

12645 Salina Dr
Jacksonville, FL 32246-2291
Phone (904) 787-8150

5900 Westgate Dr
Orlando, FL 32835-2002
Phone (407) 352-2542

6206 Atlantic Blvd
Suite 1
Jacksonville, FL 32211-7560
Phone (904) 731-7131

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Inpatient Consultants of Florida, Inc Internal Medicine CurrentSince Jul 1, 2022 Accepting new patients
Inpatient Consultants of Florida, Inc Internal Medicine Current Accepting new patients
Kopa LLC CurrentSince Jan 21, 2025 Accepting new patients
First Coast Surgical Associates Inc CurrentSince Jan 1, 2026 Accepting new patients
Inpatient Consultants of Florida Inc Internal Medicine CurrentSince Jul 1, 2022 Accepting new patients
Memorial Healthcare Group Inc Past Accepting new patients
Bold Healthcare PLLC Past Accepting new patients

Locations

6206 Atlantic Blvd
Ste 1
Jacksonville, FL 32211
Phone (904) 731-3131

3625 University Blvd S
Jacksonville, FL 32216
Phone (904) 333-9404

12645 Salina Dr
Jacksonville, FL 32246
Phone (904) 787-8150

2001 W 68th St
Miami Lakes, FL 33016
Phone (305) 364-2151

350 7th St N
Naples, FL 34102
Phone (239) 436-5000

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

5900 Westgate Dr
Orlando, FL 32835
Phone (407) 296-8164

2000 N Semoran Blvd
Orlando, FL 32807
Phone (407) 641-5400

5900 Lk Ellenor Dr
Ste 700
Orlando, FL 32809
Phone (407) 216-0101

6000 49th St N
St Petersburg, FL 33709
Phone (727) 521-4411

3030 W Bearss Ave
Tampa, FL 33618
Phone (813) 932-2222

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/PlW-EjC8LXq2pLtfi8pP4Fb9PQcNWAMu/
  • FHIR API: https://fhir4.healow.com/fhir/r4/HFEDCD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avante at Ormond Beach, Inc.Ormond Beach, FL, CCN 105310 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2025
Jan 12, 2026

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1750842142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164207",
            "telephone_number": "904-702-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164207",
            "telephone_number": "904-702-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABBOUSH",
        "first_name": "YACOB",
        "middle_name": "YOUSIF",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-27",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME156957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.