NPIMap

Individual provider Active NPI

Mary Amanda Jacobs, M.D.

  • MOHS-Micrographic Surgery Physician
  • State College, PA
National Provider Identifier
1811973894
Registry record updated Aug 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
MD437386 Issued in PA
Practice address
2188 Sandy Dr
State College, PA 16803-2288
Phone
(814) 237-6600
Fax
(814) 237-5383
NPI assigned
Dec 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 46763 MN
MOHS-Micrographic Surgery Physician 207ND0101X MD437386 PA Primary

Addresses

Primary practice location

2188 Sandy Dr
State College, PA 16803-2288

Mailing address

155 Wellness Way
State College, PA 16803-6702
Phone (814) 231-7100

Other identifiers 5

IdentifierTypeStateIssuer
ENROLLEDMedicaidIA
102337081MedicaidPA
699485700MedicaidMN
P00333407OtherMNRAILROAD MEDICARE
35163500MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20090819000336 PA Practitioner - Micrographic Dermatologic Surgery (MDS)Practitioner - Dermatology 8325016421 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Micrographic Dermatologic Surgery (MDS)
Education
Jefferson Medical College of Thomas Jefferson University, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Nittany Medical Center Health Services IncGroup PAC ID 8426136797, shared by 2 NPIs, 366 clinicians
Dubois Dermatology and Cosmetics LLCGroup PAC ID 8022324003, 4 clinicians

Practice addresses (Care Compare)

100 Scenery Dr
Uppr Level
State College, PA 16801-7997
Phone (814) 234-6600

105 Beaver Dr
Suite 200
Du Bois, PA 15801-2515
Phone (814) 371-7546

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision47
Removal of skin lesions43
Removal of skin cancer691
Skin biopsy128

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46763MNMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Current Accepting new patients
Dubois Dermatology and Cosmetics, LLC Dermatology CurrentSince Mar 1, 2024 Accepting new patients
Geisinger Clinic CurrentSince Sep 1, 2009 Accepting new patients
Geisinger Clinic CurrentSince Sep 1, 2009 Accepting new patients
Mount Nittany Medical Center Health Services Inc PastSince Jul 1, 2026 Accepting new patients
Mount Nittany Medical Center Health Services Inc PastSince Jul 1, 2026 Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

105 Beaver Dr
Ste 200
Dubois, PA 15801
Phone (814) 371-7546

155 Wellness Way
State College, PA 16803
Phone (800) 367-0179

200 Scenery Dr
State College, PA 16801
Phone (814) 231-4560

Interoperability endpoints

  • Direct secure messaging: mjacobs85689@direct.geisinger.edu

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 and National Provider Directory roles.

Hospital & facility affiliations 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787270400000",
    "number": "1811973894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 WELLNESS WAY",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036702",
            "telephone_number": "814-231-7100",
            "fax_number": "814-238-0790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2188 SANDY DR",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168032288",
            "telephone_number": "814-237-6600",
            "fax_number": "814-237-5383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "MARY",
        "middle_name": "AMANDA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2026-08-21",
        "certification_date": "2026-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "46763",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "PA",
            "license": "MD437386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102337081",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "699485700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00333407",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35163500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.