Active NPI
Eric William Jacobson, M.D.
- Rheumatology Physician
- Worcester, MA
National Provider Identifier
1992787493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 74007
- Practice address
- 55 Lake Ave N
Worcester, MA 01655-0002 - Phone
- (508) 334-5224
- NPI assigned
- Nov 18, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | 74007 | MA | Primary |
Addresses
Primary practice location
55 Lake Ave N
Worcester, MA 01655-0002
Mailing address
PO Box 415348
Boston, MA 02241-5348
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3076849 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 74007 | MA | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238025600000",
"number": "1992787493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 415348",
"city": "BOSTON",
"state": "MA",
"postal_code": "022415348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 LAKE AVE N",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016550002",
"telephone_number": "508-334-5224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "ERIC",
"middle_name": "WILLIAM",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-18",
"last_updated": "2009-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "MA",
"license": "74007",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3076849",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.