John Benjamin Jacobs, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

C7933 Issued in AR

Practice address

9755 W State Highway 22
Ratcliff, AR 72951-9000

Phone

(479) 635-5300

Fax

(479) 635-2010

NPI assigned

Jan 26, 2006

Sex

Male

Sole proprietor

No

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.

• Clarksville Medical Group, P.a.

  • Family Medicine Physician
  • Clarksville, AR
  • NPI 1447253810

  Family Medicine

  NPD
• Johnson Regional Medical Center

  • Land Ambulance
  • Clarksville, AR
  • NPI 1275753881
  NPD (past)

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

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 22, 2014.

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405987200000",
    "number": "1780654053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9755 W STATE HIGHWAY 22",
            "city": "RATCLIFF",
            "state": "AR",
            "postal_code": "729519000",
            "telephone_number": "479-635-5300",
            "fax_number": "479-635-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9755 W STATE HIGHWAY 22",
            "city": "RATCLIFF",
            "state": "AR",
            "postal_code": "729519000",
            "telephone_number": "479-635-5300",
            "fax_number": "479-635-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "JOHN",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2014-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C7933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1670799",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA INSURANCE COMPANY",
            "identifier": "7959093",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS OF MICHIGAN",
            "identifier": "XX12984",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG PROGRAM",
            "identifier": "020407900",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "0790780001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH LINK",
            "identifier": "375018",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA H&R FUNDS",
            "identifier": "0062731",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE/PALMETT",
            "identifier": "080046831",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123744001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD ARK",
            "identifier": "55027",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "15346000000",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nathan Bennett, D.O.
• Donald William Burns
• Wendy A. Gaston, APN
• Michael L Guyer, MD
• Lauren Ashley Hall
• Charles Woodrow Jones Jr., M.D.
• Thomas Donovan Kiefer, DDS
• Glenda Marie King, APRN
• Jonathan James Larsen
• Charles D Parker, M.D.

• All providers in Ratcliff, AR
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; 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.