Jacob C. Marshall Jr., M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036102192 Issued in IL

Practice address

103 N Oak St
O Fallon, IL 62269-1165

Phone

(888) 577-6337

NPI assigned

Nov 21, 2005

Last updated

Jul 12, 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

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmarsh64@yourcarecommunity.org

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.

• Memorial Hospital

  • Critical Access Hospital
  • Chester, IL
  • NPI 1851390132

  Family Medicine

  Medicare reassignment NPD
• Midwest Emergency Good Samaritan, Inc

  • Emergency Medicine Physician
  • Mount Vernon, IL
  • NPI 1629367578
  Medicare reassignment NPD
• Midwest Emergency Sparta, Inc

  • Emergency Medicine Physician
  • Sparta, IL
  • NPI 1194162370
  Medicare reassignment NPD
• Memorial Hospital

  • Institutional Pharmacy
  • Chester, IL
  • NPI 1023603289
  NPD
• Crossroads Emergency Physicians, LLP

  • Emergency Medicine Physician
  • Effingham, IL
  • NPI 1023033982
  NPD (past)
• Granite City Illinois Hospital Company LLC

  dba Gateway Urgent Care

  • Urgent Care Clinic/Center
  • Glen Carbon, IL
  • NPI 1417353087
  NPD (past)
• Hospital & Medical Foundation of Paris, Inc.

  dba Horizon Health

  • Clinic/Center
  • Paris, IL
  • NPI 1629280367

  Family Medicine

  NPD (past)
• Oakdale Medical Group Inc

  • Emergency Medicine Physician
  • Oakdale, CA
  • NPI 1598862054
  NPD (past)

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278892800000",
    "number": "1922081249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 BOWLER RD",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622347012",
            "telephone_number": "618-977-9607",
            "fax_number": "618-624-9302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 N OAK ST",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691165",
            "telephone_number": "888-577-6337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "JACOB",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2010-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-102192",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036102192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102192",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922081249",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "08232204",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102192 -8",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102192-9",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crystal Vaughn Manse, M.D.
• Johnathan Jay Marchbanks, MSW
• Alexandria Marion, RBT
• Whitney Marlow, M.D.
• Scott Benjamin Marrus, MD
• Kellee Ann Marshall, RD, LD
• Montina Marshall
• Jennifer L Martens, FNP
• Lance P Martin, DMD
• Dawn Massey

• Family Medicine Physician in O'Fallon, IL
• Providers in O'Fallon, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.