Active NPI
Lourdes R Jacobo, M.D.
- Pediatrics Physician
- Prescott, AZ
National Provider Identifier
1861548679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 40096
- Practice address
- 2120 Centerpointe West Dr
Prescott, AZ 86301-8487 - Phone
- (928) 778-4581
- Fax
- (928) 776-1872
- NPI assigned
- Jan 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 23974 | NJ | |
| Pediatrics Physician | 208000000X | 40096 | AZ | Primary |
Addresses
Primary practice location
2120 Centerpointe West Dr
Prescott, AZ 86301-8487
Mailing address
16950 N 49TH Way
Scottsdale, AZ 85254-1082
Phone (623) 238-4284
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 401708 | Medicaid | AZ | |
| 40096 | Other | AZ | LICENSE |
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 |
|---|---|---|---|
| 23974 | NJ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wee Care Family Clinic Corp | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472083200000",
"number": "1861548679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16950 N 49TH WAY",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "852541082",
"telephone_number": "623-238-4284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2120 CENTERPOINTE WEST DR",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863018487",
"telephone_number": "928-778-4581",
"fax_number": "928-776-1872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBO",
"first_name": "LOURDES",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2016-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "23974",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "AZ",
"license": "40096",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "401708",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "40096",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.