Active NPI
Daisy Jacob, M.D.
- Psychiatry Physician
- Hartford, CT
National Provider Identifier
1881661544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 20191
- Practice address
- 675 Tower Ave
Suite 301
Hartford, CT 06112-1273 - Phone
- (860) 714-2750
- Fax
- (860) 714-8591
- NPI assigned
- Mar 1, 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 20191 | CT | Primary |
Addresses
Primary practice location
675 Tower Ave
Suite 301
Hartford, CT 06112-1273
Mailing address
675 Tower Ave
Suite 301
Hartford, CT 06112-1273
Phone (860) 714-2750
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 |
|---|---|---|---|
| 20191 | CT | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bristol Hospital Multi-Specialty Group, Inc. | Psychiatry | 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.
-
- Psychiatry Physician
- Bristol, CT
- NPI 1396734109
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449792000000",
"number": "1881661544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "675 TOWER AVE",
"address_2": "SUITE 301",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061121273",
"telephone_number": "860-714-2750",
"fax_number": "860-714-8591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 TOWER AVE",
"address_2": "SUITE 301",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061121273",
"telephone_number": "860-714-2750",
"fax_number": "860-714-8591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "DAISY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-01",
"last_updated": "2015-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CT",
"license": "20191",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.