NPIMap

Individual provider Active NPI

Marianne Bernadette Jacobs, D.O.

  • Neurology Physician
  • Port Charlotte, FL
National Provider Identifier
1831118611
Registry record updated Sep 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
OS5346 Issued in FL
Practice address
3109 Silkwood LN
Port Charlotte, FL 33953-5686
Phone
(615) 345-5400
NPI assigned
Jul 19, 2006
Last updated
Sep 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 31615 CO
Pain Medicine (Psychiatry & Neurology) Physician 2084P2900X 31615 CO
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X 31615 CO
Neurology Physician 2084N0400X OS5346 FL Primary

Addresses

Primary practice location

3109 Silkwood LN
Port Charlotte, FL 33953-5686

Mailing address

3 Maryland Farms Ste 200
Brentwood, TN 37027-5005
Phone (615) 345-5400

Other identifiers 6

IdentifierTypeStateIssuer
01316157MedicaidCO
84132889816OtherSECURE HORIZONS
50813OtherCTSTATE LICENSE
57444YOtherFLMEDICARE PTAN
841328898011OtherROCKY MOUNTAIN HEALTH PLA
P01290076OtherFLRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, FL, MD3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040908000094 MN Practitioner - Neurology 8527034925 Reassigns benefits to 1 organization
I20130123000251 FL Practitioner - Neurology 8527034925 Reassigns benefits to 2 organizations
I20180802000281 MD Practitioner - Neurology 8527034925

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Remote Neuromonitoring Physicians PCGroup PAC ID 1355495961, 36 clinicians
Sentient Physicians, P.C.Group PAC ID 2668764333, 37 clinicians

Practice addresses (Care Compare)

3109 Silkwood LN
Port Charlotte, FL 33953-5686
Phone (800) 348-4565

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31615COMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin Healthcare System, Inc Current Accepting new patients
Sentient Physicians, P.C. Neurology CurrentSince Dec 3, 2016 Accepting new patients
Hennepin Healthcare System, Inc CurrentSince Apr 2, 2018 Accepting new patients
Hennepin Healthcare System Inc CurrentSince Apr 2, 2018 Accepting new patients
First Care Physicians LLP Neurology PastSince Jul 1, 1998 Accepting new patients
All Family Clinic of Daytona Beach, Inc Past Accepting new patients

Locations

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

701 Park Ave
#350
Minneapolis, MN 55415
Phone (612) 873-5334

3 Maryland Farms
Ste 200
Brentwood, TN 37027
Phone (615) 346-8733

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: mjacobs648390@direct.shands.ufl.edu

Organizations & group practices 7

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1831118611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MARYLAND FARMS STE 200",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275005",
            "telephone_number": "615-345-5400",
            "fax_number": "615-345-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 SILKWOOD LN",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339535686",
            "telephone_number": "615-345-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "MARIANNE",
        "middle_name": "BERNADETTE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CO",
            "license": "31615",
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "CO",
            "license": "31615",
            "primary": false
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "CO",
            "license": "31615",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "OS5346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01316157",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURE HORIZONS",
            "identifier": "84132889816",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "50813",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "57444Y",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ROCKY MOUNTAIN HEALTH PLA",
            "identifier": "841328898011",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01290076",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.