Jacob Borg, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY8488 Issued in FL

Practice address

4 Office Park Dr
Palm Coast, FL 32137-3855

Phone

(386) 986-7222

Fax

(386) 401-2414

NPI assigned

Sep 19, 2012

Sex

Male

Sole proprietor

Yes

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 FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Verones and Associates

  • Community/Behavioral Health Agency
  • Palm Coast, FL
  • NPI 1114249638
  NPD (past)

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723248000000",
    "number": "1902157761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 OFFICE PARK DR",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373855",
            "telephone_number": "386-986-7222",
            "fax_number": "386-401-2414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 OFFICE PARK DR",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373855",
            "telephone_number": "386-986-7222",
            "fax_number": "386-401-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORG",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-19",
        "last_updated": "2024-08-10",
        "certification_date": "2024-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "004633",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY8488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Cara Bonds, APRN
• Victoria Bongiorno, MS, RD, CPT
• Raymond Bonner Jr., RN
• Trissa-Ann Elaine Boone, BT
• Gynnekia Marie Booth
• Tracy Lynn Bossbach
• Ramez Rashad Halim Botros
• Jennifer Marie Bottke, FNP-BC
• Mary Bottom, COTA
• Boulder Rock Dental, LLC

• Psychologist in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2024; 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.