Active NPI
Nancy Anne Jacob, PA-C
- Medical Physician Assistant
- Philadelphia, PA
National Provider Identifier
1962528174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- MA052520
- Practice address
- 3400 Spruce St
Ground Rhoads
Philadelphia, PA 19104-4206 - Phone
- (215) 662-7355
- NPI assigned
- Mar 21, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | MA052520 | PA | Primary |
Addresses
Primary practice location
3400 Spruce St
Ground Rhoads
Philadelphia, PA 19104-4206
Mailing address
3400 Spruce St
Ground Rhoads
Philadelphia, PA 19104-4206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CHS Physician Partners, P.C | Current | Accepting new patients | |
| CHS Physician Partners, PC | Current | Accepting new patients |
Locations
245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141
1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012
100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
Interoperability endpoints
- njacob86476@nychhc.direct-ci.com
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.
-
- Interventional Cardiology Physician
- Fresh Meadows, NY
- NPI 1407089345
-
- Cardiovascular Disease Physician
- Roslyn, NY
- NPI 1164585725
-
- Pain Medicine (Anesthesiology) Physician
- Greenvale, NY
- NPI 1124497771
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298332800000",
"number": "1962528174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 SPRUCE ST",
"address_2": "GROUND RHOADS",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 SPRUCE ST",
"address_2": "GROUND RHOADS",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044206",
"telephone_number": "215-662-7355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "NANCY",
"middle_name": "ANNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-21",
"last_updated": "2011-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "MA052520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2011; 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.