Active NPI
Jim Jacob, PT
- Physical Therapist
- Plymouth, IN
National Provider Identifier
1790767887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05008652A
- Practice address
- 900 W Jefferson St
Plymouth, IN 46563-1634 - Phone
- (574) 936-9600
- Fax
- (574) 936-9612
- NPI assigned
- Nov 15, 2005
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05008652A | IN | Primary |
Addresses
Primary practice location
900 W Jefferson St
Plymouth, IN 46563-1634
Mailing address
PO Box 308
Mishawaka, IN 46546-0308
Phone (574) 273-6546
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05008652A | IN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apex Therapy Services, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790767887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 308",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465460308",
"telephone_number": "574-273-6546",
"fax_number": "574-273-5295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 W JEFFERSON ST",
"city": "PLYMOUTH",
"state": "IN",
"postal_code": "465631634",
"telephone_number": "574-936-9600",
"fax_number": "574-936-9612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "JIM",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05008652A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.