David T Jacobs, MD

Primary specialty

Phlebology PhysicianTaxonomy code 202K00000X

License

257302 Issued in NY

Practice address

24 Maple Ave Ste 2
Rockville Centre, NY 11570-4259

Phone

(516) 865-1234

NPI assigned

Nov 22, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Diagnostic Radiology

Education

New York University School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: david.jacobs.1@31597.direct.athenahealth.com

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Venetian Care and Rehabilitation Center

  • Skilled Nursing Facility
  • South Amboy, NJ
  • NPI 1952736985

  5% Or Greater Direct Ownership Interest

  CMS ownership

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.

• Jacobs Radiology PLLC

  dba South Shore Vein and Image-Guided Medicine

  • Phlebology Physician
  • Rockville Centre, NY
  • NPI 1255866372

  Single Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1258848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537401600000",
    "number": "1811225394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 EDWARD AVE",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115982823",
            "telephone_number": "646-831-2744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 MAPLE AVE STE 2",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115704259",
            "telephone_number": "516-865-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "DAVID",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-11-22",
        "last_updated": "2018-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "XXXXXXX",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "NY",
            "license": "257302",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "257302",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NY",
            "license": "257302",
            "primary": false
        },
        {
            "code": "202K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Phlebology",
            "state": "NY",
            "license": "257302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICENSE",
            "identifier": "257302",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Muataz Jaber, MD
• Kim Rene Jackman
• Noreen Jackson-Iacobellis, MS-CCC, SLP
• Jacobs Radiology PLLC (South Shore Vein and Image-Guided Medicine)
• Bradford Elliot Jacobs, PH.D.
• Donn R Jacobs, DDS
• Steven Andrew Jacobs, D.O.
• Andrew Gene Jacobson, D.M.D.
• Howard Jacobson, R.PH.
• Lisa Jacobson

• Phlebology Physician in Rockville Centre, NY
• Providers in Rockville Centre, NY by specialty
• Phlebology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.