NPIMap

Individual provider Active NPI

Jacob Joseph Tom, MD

  • Diagnostic Radiology Physician
  • Springfield, OR
National Provider Identifier
1912972258
Registry record updated Jun 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
39631 Issued in WA
Practice address
960 N 16TH St Ste 103
Springfield, OR 97477-4175
Phone
(541) 726-4694
Fax
(541) 744-6069
NPI assigned
Feb 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 39631 WA Primary

Addresses

Primary practice location

960 N 16TH St Ste 103
Springfield, OR 97477-4175

Mailing address

696 N Shepherd Rd
Washougal, WA 98671-8320
Phone (360) 281-6432

Other identifiers 1

IdentifierTypeStateIssuer
287539MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20080603000288 OR Practitioner - Diagnostic Radiology 0244227809 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Baylor College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Singleton Associates PAGroup PAC ID 6305731118, 814 clinicians

Practice addresses (Care Compare)

1426 I St
Springfield, OR 97477-4116
Phone (713) 861-7164

2401 River Rd
Eugene, OR 97404-5414
Phone (541) 726-4699

Hospital & facility affiliations

  • Memorial Hermann Hospital System Hospital, Houston, TX, CCN 450184
  • Memorial Hermann Northeast Hospital Hospital, Humble, TX, CCN 450684
  • Sweeny Community Hospital Hospital, Sweeny, TX, CCN 451311
  • Rice Medical Center Hospital, Eagle Lake, TX, CCN 451312

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39631WAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McKenzie Medical Imaging PC Current Accepting new patients
Direct Radiology PLLC Diagnostic Radiology CurrentSince May 8, 2013 Accepting new patients
Willamette Valley Mammography CurrentSince Jul 1, 2008 Accepting new patients
Singleton Associates PA Diagnostic Radiology CurrentSince Mar 31, 2024 Accepting new patients

Locations

2401 River Rd
Eugene, OR 97404
Phone (541) 726-4699

960 N 16th St
Ste 10
Springfield, OR 97477
Phone (541) 726-4959

960 N 16th St
Ste 103
Springfield, OR 97477
Phone (541) 726-4694

6720 Bertner Ave
#2270
Houston, TX 77030
Phone (832) 355-4092

920 Hillcrest Dr
Vernon, TX 76384
Phone (940) 552-9351

Organizations & group practices 4

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 10

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307491200000",
    "number": "1912972258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "696 N SHEPHERD RD",
            "city": "WASHOUGAL",
            "state": "WA",
            "postal_code": "986718320",
            "telephone_number": "360-281-6432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 N 16TH ST STE 103",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974774175",
            "telephone_number": "541-726-4694",
            "fax_number": "541-744-6069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOM",
        "first_name": "JACOB",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2011-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "39631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287539",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.