NPIMap

Individual provider Active NPI

Jaymi Ann Jacob

  • Optometrist
  • Fort Worth, TX
National Provider Identifier
1871263020
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10434 Issued in TX
Practice address
9549 Sage Meadow TRL
Fort Worth, TX 76177-8595
Phone
(469) 441-7713
NPI assigned
Sep 19, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 10434 TX Primary

Addresses

Primary practice location

9549 Sage Meadow TRL
Fort Worth, TX 76177-8595

Mailing address

9549 Sage Meadow TRL
Fort Worth, TX 76177-8595
Phone (817) 428-4182

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20230302000604 TX Practitioner - Optometry 0244603876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
International American University at Puerto Rico - School of Optometry, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dallas County Hospital DistrictGroup PAC ID 8325934813, 597 clinicians

Practice addresses (Care Compare)

3560 W Camp Wisdom Rd
100 Parkland Health
Dallas, TX 75237-2506
Phone (214) 266-0003

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.1 of 100Reported as group
Quality
88.97
Promoting interoperability
79
Improvement activities
40
Cost
83.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10434TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dallas County Hospital District CurrentSince Jan 25, 2023 Accepting new patients
Dallas County Hospital District Current Accepting new patients
Dallas County Hospital District Optometrist CurrentSince Jan 25, 2023 Accepting new patients

Locations

3560 W Camp Wisdom Rd
Ste 100
Dallas, TX 75237
Phone (214) 266-4000

5151 Maple Ave
#4A
Dallas, TX 75235
Phone (214) 590-2800

1800 N Britain Rd
Irving, TX 75061
Phone (214) 266-3000

Organizations & group practices 4

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 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1632009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1871263020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9549 SAGE MEADOW TRL",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761778595",
            "telephone_number": "817-428-4182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9549 SAGE MEADOW TRL",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761778595",
            "telephone_number": "469-441-7713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JAYMI",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-19",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "10434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.