Clyde Tyrone Jacob III, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

81399 Issued in GA

Practice address

6325 Hospital Pkwy
Johns Creek, GA 30097-5775

Phone

(678) 474-7000

NPI assigned

Aug 9, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NJ, GA, DE, FL, WA, AR, MD7 enrollments

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 7

Specialty

Obstetrics/Gynecology

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

DHP of Manatee PAGroup PAC ID 5799016846, 45 clinicians

DHP of Arkansas PAGroup PAC ID 3779731104, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventhealth Tampa Hospital, Tampa, FL, CCN 100173

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 28)

Interoperability endpoints

• Direct secure messaging: cjacob3089134@direct.trinity-health.org

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.

• DHP of Arkansas PA

  • Obstetrics & Gynecology Physician
  • Little Rock, AR
  • NPI 1992068878

  AR, Obstetrics & Gynecology

  Medicare reassignment Care Compare group NPD
• DHP of Manatee PA

  • Obstetrics & Gynecology Physician
  • Mangonia Park, FL
  • NPI 1134771611

  FL, Obstetrics & Gynecology

  Medicare reassignment Care Compare group NPD
• Obhg Georgia, P.C.

  • Obstetrics & Gynecology Physician
  • Athens, GA
  • NPI 1750686838

  GA, Obstetrics & Gynecology

  Medicare reassignment NPD
• The Emory Clinic Inc

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1396798229

  GA

  Medicare reassignment NPD
• DHP of Delaware, Inc.

  • Obstetrics & Gynecology Physician
  • Seaford, DE
  • NPI 1558000919

  DE, Obstetrics & Gynecology

  Medicare reassignment NPD
• DHP of Pennsylvania PC

  • Obstetrics & Gynecology Physician
  • Salisbury, MD
  • NPI 1427313717

  MD, Obstetrics & Gynecology

  Medicare reassignment NPD
• Obhg Washington, PC

  • Obstetrics & Gynecology Physician
  • Silverdale, WA
  • NPI 1962729525

  Obstetrics & Gynecology, WA

  Medicare reassignment NPD
• Obstetrix Medical Group of Washington Inc PS

  • Maternal & Fetal Medicine Physician
  • Seattle, WA
  • NPI 1861599573

  Obstetrics & Gynecology, WA

  Medicare reassignment NPD
• DHP of Piedmont PC

  • Obstetrics & Gynecology Physician
  • Fayetteville, GA
  • NPI 1316202609

  GA

  Medicare reassignment
• DHP of New Jersey PA

  • Obstetrics & Gynecology Physician
  • Edison, NJ
  • NPI 1275896516

  NJ

  Medicare reassignment
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  NPD

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

• University Community Hospital, Inc

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1053321919

  Hospital

  Care Compare affiliation
• University Community Hospital, Inc

  • Clinical Medical Laboratory
  • Tampa, FL
  • NPI 1134766694

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1972504488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5950 CABOTAGE RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300978475",
            "telephone_number": "908-397-2019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6325 HOSPITAL PKWY",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300975775",
            "telephone_number": "678-474-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3950 Austell Rd",
            "address_purpose": "LOCATION",
            "city": "Austell",
            "state": "GA",
            "postal_code": "301061121",
            "country_code": "US",
            "telephone_number": "770-793-5913",
            "fax_number": "770-999-2445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "CLYDE",
        "middle_name": "TYRONE",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2023-12-14",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "01089636A",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "1999591",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME162114",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "DE",
            "license": "C1-0025884",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "25MA09347700",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "81399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02219496",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cjacob534112@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3950 Austell Rd",
            "city": "Austell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301061121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Megan Christina Izutani, RDH
• Aubrey Jackson
• Bridgitte L. Jackson, FNP, AOCN
• Denise Jackson
• Katherine Justina Jackson, MSN, WHNP-BC
• Amanda Jacobs, DPT
• Skyler J Jacobs, CNM
• Janet Rita James
• Saraswathi Jampala, MD
• Devipriya Janakiramin, O.D.

• All providers in Johns Creek, GA
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; 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.