Active NPI
Gary Lee Jacobs, CRNA
- Certified Registered Nurse Anesthetist
- McComb, MS
National Provider Identifier
1861502155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- R550884
- Practice address
- 215 Marion Ave
McComb, MS 39648-2705 - Phone
- (601) 249-5500
- Fax
- (601) 249-1709
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R550884 | MS | Primary |
Addresses
Primary practice location
215 Marion Ave
McComb, MS 39648-2705
Mailing address
215 Marion Ave
McComb, MS 39648-2705
Phone (601) 249-5500
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R550884 | MS | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861502155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 MARION AVE",
"city": "MCCOMB",
"state": "MS",
"postal_code": "396482705",
"telephone_number": "601-249-5500",
"fax_number": "601-249-1709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 MARION AVE",
"city": "MCCOMB",
"state": "MS",
"postal_code": "396482705",
"telephone_number": "601-249-5500",
"fax_number": "601-249-1709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "GARY",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "CRNA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MS",
"license": "R550884",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McComb, MS
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.