Mithun George Jacob, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

1015486 Issued in MA

Practice address

759 Chestnut St Ste C3350
Springfield, MA 01107-1619

Phone

(413) 794-6297

Fax

(413) 794-1767

NPI assigned

Aug 17, 2020

Sex

Male

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 MA

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

HospitalistAlso: Internal Medicine

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baystate Medical Practices IncGroup PAC ID 5991602971, 1,350 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baystate Medical Center Hospital, Springfield, MA, CCN 220077
• Baystate Franklin Medical Center Hospital, Greenfield, MA, CCN 220016

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 and National Provider Directory roles.

• Baystate Medical Practices, Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Springfield, MA
  • NPI 1548205909

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Baystate Franklin Medical Center

  • General Acute Care Hospital
  • Greenfield, MA
  • NPI 1508867391
  NPD (past)
• Baystate Medical Center Inc

  • General Acute Care Hospital
  • Springfield, MA
  • NPI 1487655064
  NPD (past)

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

• Baystate Franklin Medical Center

  • General Acute Care Hospital
  • Greenfield, MA
  • NPI 1508867391
  Care Compare affiliation
• Baystate Medical Center Inc

  • General Acute Care Hospital
  • Springfield, MA
  • NPI 1487655064
  Care Compare affiliation
• Baystate Medical Center Inc

  • Clinical Medical Laboratory
  • Springfield, MA
  • NPI 1568488450

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719705600000",
    "number": "1912519489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 CHESTNUT ST FL 2",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011991001",
            "telephone_number": "413-794-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "759 CHESTNUT ST STE C3350",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011071619",
            "telephone_number": "413-794-6297",
            "fax_number": "413-794-1767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "MITHUN",
        "middle_name": "GEORGE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-17",
        "last_updated": "2024-06-30",
        "certification_date": "2024-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MA",
            "license": "1015486",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "1015486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanne Jackson, NP
• Joshua Jackson
• Rainelle Jackson
• Talaisha Jackson
• Jackcy Jacob, MD
• Bridget Ranae Jacobs-Holmes, RPT
• Barry R Jacobs, MD
• Carla F Jacobs, DO
• Jakyira Jacobs
• Dayna Jacobson, P.A.-C

• Internal Medicine Physician in Springfield, MA
• Providers in Springfield, MA by specialty
• Internal Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.