NPIMap

Individual provider Active NPI

Gregory Jacobs, DO

  • Family Medicine Physician
  • Saint Cloud, MN
National Provider Identifier
1790429595
Registry record updated Jun 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
78055 Issued in MN
Practice address
1555 Northway Dr Ste 200
Saint Cloud, MN 56303-4913
Phone
(320) 240-3157
Fax
(320) 240-3165
NPI assigned
Apr 26, 2022
Last updated
Jun 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2025

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
Family Medicine Physician 207Q00000X 78055 MN Primary

Addresses

Primary practice location

1555 Northway Dr Ste 200
Saint Cloud, MN 56303-4913

Mailing address

1555 Northway Dr Ste 100
Saint Cloud, MN 56303-1258
Phone (320) 240-3157

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20241126000731 MN Practitioner - Family Practice 7719366327 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians
St Cloud HospitalGroup PAC ID 4880594779, 215 clinicians

Practice addresses (Care Compare)

1301 33Rd St S
St Cloud, MN 56301-9668
Phone (320) 251-8181

1555 Northway Dr
Suite 200
Saint Cloud, MN 56303-4913
Phone (320) 240-3157

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
78055MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
St. Cloud Hospital Current Accepting new patients
Centracare Clinic CurrentSince Nov 1, 2024 Accepting new patients
Centracare Clinic CurrentSince Nov 1, 2024 Accepting new patients
St. Cloud Hospital CurrentSince Nov 1, 2024 Accepting new patients
St. Cloud Hospital CurrentSince Nov 1, 2024 Accepting new patients

Locations

12800 Rolling Ridge Rd
Becker, MN 55308
Phone (763) 261-7000

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1301 33rd St S
Saint Cloud, MN 56301
Phone (320) 240-6955

1555 Northway Dr
#H
Saint Cloud, MN 56303
Phone (320) 240-3157

1555 Northway Dr
Ste 100
Saint Cloud, MN 56303
Phone (320) 240-1775

1555 Northway Dr
Ste 200
Saint Cloud, MN 56303
Phone (320) 240-3157

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: gjacobs622110@direct.centracare.com

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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": "1650931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750550400000",
    "number": "1790429595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 NORTHWAY DR STE 100",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031258",
            "telephone_number": "320-240-3157",
            "fax_number": "320-240-3165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 NORTHWAY DR STE 200",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034913",
            "telephone_number": "320-240-3157",
            "fax_number": "320-240-3165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "GREGORY",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-26",
        "last_updated": "2025-06-22",
        "certification_date": "2025-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "78055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.