Richard Samuel Jacobson, M,D,

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

G15588 Issued in CA

Practice address

10515 Balboa BL.
Suite 250
Granada Hills, CA 91344

Phone

(818) 831-2343

NPI assigned

Feb 12, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

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

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.

• County of Los Angeles

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1851363188
  Medicare reassignment NPD
• County of Los Angeles

  • State or Local Public Health Clinic/Center
  • Los Angeles, CA
  • NPI 1952595704
  NPD

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345507200000",
    "number": "1952443673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11591 YARMOUTH AVE",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913442102",
            "telephone_number": "818-366-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10515 BALBOA BL.",
            "address_2": "SUITE 250",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "91344",
            "telephone_number": "818-831-2343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "RICHARD",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "M,D,",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2012-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "CA",
            "license": "G15588",
            "primary": false
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "CA",
            "license": "G15588",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G15588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G155880",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUM",
            "identifier": "G15588",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Stephanie Izen, AMFT
• La Tina Monique Jackson, LCSW
• Jacob Offenberger MD Inc
• Evelinda D Jacob, DDS
• Karen Jacobson, PT
• Jeremy Jalbuena
• James D. Thomas, M.D. P C
• Janet Schrodi DMD, Inc.
• Evelyn Dianna Jankowski, MD
• Eduardo Benjamin Jaramillo

• Psychiatry Physician in Granada Hills, CA
• Providers in Granada Hills, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; 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.