Jon R Jacobson, D.O.

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

License

036149530 Issued in IL

Practice address

1512 N Green Mount Rd
O Fallon, IL 62269-2083

Phone

(618) 628-8440

NPI assigned

Nov 6, 2006

Last updated

Dec 30, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jjacobson263066@ewd.direct.hshs.org

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.

• HSHS Prairie, Inc

  • Multi-Specialty Clinic/Center
  • Springfield, IL
  • NPI 1962644807

  Single Specialty

  Medicare reassignment NPD
• HSHS Prairie, Inc

  dba HSHS Medical Group Family Medicine - Dieterich

  • Rural Health Clinic/Center
  • Dieterich, IL
  • NPI 1033841192
  NPD
• SJL Health Systems Inc

  dba Prairie Rose Health Care Center

  • Skilled Nursing Facility
  • Pana, IL
  • NPI 1215037353
  NPD

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1780753822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 N GREEN MOUNT RD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692083",
            "telephone_number": "618-628-8440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 N GREEN MOUNT RD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692083",
            "telephone_number": "618-628-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "JON",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "IL",
            "license": "036149530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jjacobson263066@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1512 N Green Mount Rd",
            "city": "O Fallon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622692083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Diane Rene Jackson, LMSW-ACP
• Jessica Jackson
• Joanne Jackson
• Joseph Jackson
• Kaylee Soraya Jackson
• Jacquelyn Hall-Davis,M.D. LTD
• Eric R James
• Jodi Jany, AGNP
• Michelle Renee Jenkel
• Alex Jenkins

• Occupational Medicine Physician in O'Fallon, IL
• Providers in O'Fallon, IL by specialty
• Occupational Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.