Active NPI
Susan Jacob, M.C.
- Family Medicine Physician
- Bloomingdale, IL
National Provider Identifier
1831136019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036-110462
- Practice address
- 303 E Army Trail Rd
Ste 410a
Bloomingdale, IL 60108-2169 - Phone
- (630) 893-8161
- Fax
- (630) 893-8564
- NPI assigned
- May 31, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-110462 | IL | Primary |
Addresses
Primary practice location
303 E Army Trail Rd
Ste 410a
Bloomingdale, IL 60108-2169
Mailing address
PO Box 7009
Bolingbrook, IL 60440-7009
Phone (630) 893-8161
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036-110462 | Medicaid | IL | |
| CN4921 | Other | RRMC | |
| 209398 | Other | GROUP MEDICARE PTAN |
Other names 1
- Miss Susan John
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-110462 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Acute Care Specialists II, LTD | Past | Accepting new patients | |
| Illinois Emergency Medicine Specialists, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Glendale Heights, IL
- NPI 1205974433
-
- Emergency Medical Services (Emergency Medicine) Physician
- Bolingbrook, IL
- NPI 1003150962
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1831136019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7009",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604407009",
"telephone_number": "630-893-8161",
"fax_number": "630-893-8564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 E ARMY TRAIL RD",
"address_2": "STE 410A",
"city": "BLOOMINGDALE",
"state": "IL",
"postal_code": "601082169",
"telephone_number": "630-893-8161",
"fax_number": "630-893-8564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "M.C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-31",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036-110462",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036-110462",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RRMC",
"identifier": "CN4921",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICARE PTAN",
"identifier": "209398",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "JOHN",
"prefix": "MISS",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Bloomingdale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.