Emmanuel Egipto Jacob, M.D

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD026644E Issued in PA

Practice address

39 South River Street
Plains, PA 18705

Phone

(570) 822-9514

Fax

(570) 823-8039

NPI assigned

Oct 2, 2006

Last updated

Dec 17, 2010By the provider in NPPES

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 PA

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

Physical Medicine and Rehabilitation

Education

Perelman School of Med at the University of Pennsylvania, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Wyoming Valley Pain Clinic & Rehabilitation Center

  • Specialist
  • Plains, PA
  • NPI 1780704619
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292544000000",
    "number": "1912090689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 SOUTH RIVER STREET",
            "city": "PLAINS",
            "state": "PA",
            "postal_code": "18705",
            "telephone_number": "570-822-9514",
            "fax_number": "570-823-8039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 SOUTH RIVER STREET",
            "city": "PLAINS",
            "state": "PA",
            "postal_code": "18705",
            "telephone_number": "570-822-9514",
            "fax_number": "570-823-8039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "EMMANUEL",
        "middle_name": "EGIPTO",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2010-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "PA",
            "license": "AK000322L",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD026644E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Hartman, MSPT
• Gerald W. Haydock, D.D.S.
• Richard Haydt
• Ericka Marie Hornak, PT
• Insight Wellness, LLC
• Melissa Marie Janosov
• Charles Jobst III, CSA
• Nicholas Kachur, CRNA
• Keystone Surgical Assistants Inc.
• Raymond Khoudary, MD

• Specialist in Plains, PA
• Providers in Plains, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2010; 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.