Mark Edwin Jacobson, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

A436310 Issued in CA

Practice address

1260 N Dutton Ave Ste 160
Santa Rosa, CA 95401-7139

Phone

(707) 524-2442

Fax

(707) 524-2438

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• University of California SFGH Medical Group

  dba UCSF SFGH Medical Group Division of Vascular Surgery

  • Vascular Surgery Physician
  • San Francisco, CA
  • NPI 1033913959
  NPD (past)
• University of California SFGH Medical Group

  dba UCSF SFGH Medical Group Dept of Ophthalmology

  • Ophthalmology Physician
  • San Francisco, CA
  • NPI 1770558827
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1770509002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 N DUTTON AVE STE 160",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954017139",
            "telephone_number": "707-524-2442",
            "fax_number": "707-524-2438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 N DUTTON AVE STE 160",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954017139",
            "telephone_number": "707-524-2442",
            "fax_number": "707-524-2438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "MARK",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A436310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00S436310",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "401 Bicentennial Way",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954032149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jon Gustaf Jackson, M.D.
• Michelle Lorraine Jackson, ASW
• Joshua Jacober, MD
• Gerald D. Jacobs
• Robert Louis Jacobs
• Jafa Pharmaceuticals, Inc. (Creekside Pharmacy)
• Jafa Pharmaceuticals, Inc. (Creekside Pharmacy)
• Mahsa Sadat Jafari
• Robert Torin Jaffe, M.D.
• Ida Jahed, MD

• Ophthalmology Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.