NPIMap

Individual provider Active NPI

John Michael Jacobs, MD

  • Family Medicine Physician
  • South Bend, IN
National Provider Identifier
1881785046
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01034365 Issued in IN
Practice address
6301 University Commons Ste 210
South Bend, IN 46635-1590
Phone
(574) 234-4016
Fax
(574) 239-4607
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01034365 IN Primary

Addresses

Primary practice location

6301 University Commons Ste 210
South Bend, IN 46635-1590

Mailing address

6301 University Commons Ste 210
South Bend, IN 46635-1590
Phone (574) 234-4016

Other identifiers 1

IdentifierTypeStateIssuer
100333920AMedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address john.jacobs@fmsb.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20100805000458 IN Practitioner - Family Practice 4789727215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Medicine of South Bend PCGroup PAC ID 5395659882, 8 clinicians

Practice addresses (Care Compare)

6301 University Commons
Suite 210
South Bend, IN 46635-1590
Phone 5742344016203

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01034365INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medicine of South Bend PC Family Medicine CurrentSince Aug 8, 1987 Accepting new patients

Locations

610 N Michigan St
Ste 308
South Bend, IN 46601
Phone (219) 234-4016

6301 University Commons
Ste 210
South Bend, IN 46635
Phone (574) 234-4016

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FGJBCD
  • Direct secure messaging: johnjacobs@fmsbpc.allscriptsdirect.net

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1881785046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 UNIVERSITY COMMONS STE 210",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351590",
            "telephone_number": "574-234-4016",
            "fax_number": "574-239-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 UNIVERSITY COMMONS STE 210",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351590",
            "telephone_number": "574-234-4016",
            "fax_number": "574-239-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01034365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100333920A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john.jacobs@fmsb.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "e-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6301 University Commons Ste 210",
            "city": "South Bend",
            "state": "IN",
            "country_code": "US",
            "postal_code": "466351590",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.