Lisa Roselin Jacob, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

4301109137 Issued in MI

Practice address

6777 W Maple Rd
West Bloomfield, MI 48322

Phone

(313) 205-8581

NPI assigned

Apr 29, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

George Washington University School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Henry Ford West Bloomfield HospitalGroup PAC ID 2264589449, 83 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health West Bloomfield Hospital Hospital, W Bloomfield, MI, CCN 230302
• Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ljacob422274@direct.hfhs.org
• FHIR API: https://fhir.hfhs.org/FHIRProxy/api/FHIR/R4/

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.

• Henry Ford Health System

  • Anesthesiology Physician
  • Detroit, MI
  • NPI 1003989690
  Medicare reassignment Care Compare group NPD
• Henry Ford West Bloomfield Hospital

  • Anesthesiology Physician
  • West Bloomfield, MI
  • NPI 1518104686
  Medicare reassignment Care Compare group
• Henry Ford Health System

  • Podiatrist
  • Detroit, MI
  • NPI 1396824207
  NPD
• Henry Ford Health System

  • Community/Retail Pharmacy
  • Plymouth, MI
  • NPI 1942931720
  NPD

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

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Care Compare affiliation
• Henry Ford Health System

  dba Henry Ford West Bloomfield Hospital

  • General Acute Care Hospital
  • West Bloomfield, MI
  • NPI 1407867559
  Care Compare affiliation

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

{
    "created_epoch": "1272499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530748800000",
    "number": "1871810879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6199 WINCLIFF DR",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483224800",
            "telephone_number": "610-247-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6777 W MAPLE RD",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "48322",
            "telephone_number": "313-205-8581"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "251 E Huron St",
            "address_2": "Ste 7-503",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606112908",
            "country_code": "US",
            "telephone_number": "312-695-4387",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "LISA",
        "middle_name": "ROSELIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-29",
        "last_updated": "2018-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036138036",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301109137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rodger Dale Jackson Jr., DO, MPH
• Jacob Kalo, M.D.
• Jacob Kawwas DDS PLLC
• Angela Renee Jacob, D.P.M.
• Bruce Michael Jacob, D.P.M.
• Dennis Joseph Jacobs, PH.D.
• Howard Paul Jacobs, RPH
• Kulsoom Jafri, O.D
• Syed Mehdi Ali Jafri, DO
• Christopher George Jaghab, D.D.S.

• Anesthesiology Physician in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Anesthesiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.