CHRIS JACOB DO
NPI 1790163962
Student in an Organized Health Care Education/Training Program in Saint Clair Shores, MI

NPI Status: Active since May 08, 2015

Contact Information

24211 LITTLE MACK AVE
SAINT CLAIR SHORES, MI
ZIP 48080
Phone: (586) 498-0440
Fax: (586) 498-0401

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  • Individual
  • Male
  • Years of Experience 11
  • Student in an Organized Health Care Educ...
  • Accepts Medicare Approved Payment
  • PECOS Enrolled

About CHRIS JACOB

This page provides the complete NPI Profile along with additional information for Chris Jacob, a primary care provider established in Saint Clair Shores, Michigan with a medical specialization in Student In An Organized Health Care Education/training Program and more than 11 years of experience. He graduated from Michigan State University College Of Osteopathic Medicine in 2015. The healthcare provider is registered in the NPI registry with number 1790163962 assigned on May 2015. The practitioner's primary taxonomy code is 390200000X with license number 5151009894 (MI). The provider is registered as an individual and his NPI record was last updated 4 years ago.

NPI
1790163962
Provider Name
CHRIS JACOB DO
Gender
Male
Entity Type
Individual
Location Address
24211 LITTLE MACK AVE SAINT CLAIR SHORES, MI 48080
Location Phone
(586) 498-0440
Location Fax
(586) 498-0401
Mailing Address
601 ELMWOOD AVE BOX MED ROCHESTER, NY 14642
Mailing Phone
(585) 275-4912
Mailing Fax
(586) 498-0401
Medical School Name
MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Graduation Year
2015
Is Sole Proprietor?
No
Enumeration Date
05-08-2015
Last Update Date
06-29-2021
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A primary care provider (PCP) like Chris Jacob sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

Location Map

Secondary Locations

  • 1000 Oakland Dr
    Kalamazoo, MI 49008
    (269) 337-6115
  • 1000 Oakland Dr
    Kalamazoo, MI 49008
    (269) 337-6115
  • 601 Elmwood Ave.
    Rochester, NY 14642
    (585) 275-4912

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Student in an Organized Health Care Education/Training Program

Taxonomy Code
390200000X
Type
Student, Health Care
License No.
5151009894
License State
MI
Taxonomy Description
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1207R00000XAllopathic & Osteopathic Physicians

Internal Medicine

5101021621 (MI)
2208M00000XAllopathic & Osteopathic Physicians

Hospitalist

293779 (NY)
3390200000XStudent, Health Care

Student in an Organized Health Care Education/Training Program

5101021621 (MI)

Medicare Participation & PECOS Enrollment Status

Chris Jacob is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Chris Jacob is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 749595908

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20241203000776

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Chris Jacob is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
MCLAREN NORTHERN MICHIGAN416 CONNABLE AVE
PETOSKEY, MI 49770
(231) 487-4000Acute Care Hospitals

Reviews for CHRIS JACOB DO

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1790163962
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
27180266912
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 1 + 8 + 0 + 2 + 6 + 6 + 9 + 1 + 2 + 24 = 68
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 68 = 22

The NPI number 1790163962 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 17 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1699725606 GEORGES B GHAFARI MD
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
ST CLAIR SHORES, MI 48080
(586) 498-0440
1548325186RUDY J VERVAEKE MD PLC
Organization
Internal Medicine (Addiction Medicine)24211 LITTLE MACK AVE
SAINT CLAIR SHORES, MI 48080
(586) 775-7400
1790832319MRS. MARNI LYNN YOUNG NP
Individual
Nurse Practitioner (Acute Care)24211 LITTLE MACK AVE
SAINT CLAIR SHORES, MI 48080
(586) 498-0440
1730232463MS. MICHELLE LYNN SLOAN RN, MSN, APN, BC
Individual
Nurse Practitioner (Adult Health)24211 LITTLE MACK AVE
SAINT CLAIR SHORES, MI 48080
(586) 498-0440
1104899269DR. GEORGE B GHANEM MD
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
ST CLAIR SHORES, MI 48080
(586) 498-0440
1407804958 BASIL MOHAMMED DUDAR MD
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
ST CLAIR SHORES, MI 48080
(586) 498-0440
1508814989 MARC OLIVER GOSSELIN DO
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
ST CLAIR SHORES, MI 48080
(586) 498-0440
1124077953DR. JOAN S CRAWFORD DO
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
ST CLAIR SHORES, MI 48080
(586) 498-0440
1952350126 BRILIO CONRADO MOJARES MD
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
ST CLAIR SHORES, MI 48080
(586) 498-0440
1881643955 ANTHONY J KAWA DO
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
ST CLAIR SHORES, MI 48080
(586) 498-0440
1497704191 THOMAS ALEXANDER LALONDE MD
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
ST CLAIR SHORES, MI 48080
(586) 498-0440
1811946643DR. WILLIAM JOHN CUSHING MD
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
ST CLAIR SHORES, MI 48080
(586) 498-0440
1982657474EASTLAKE CARDIOVASCULAR PC
Organization
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
ST CLAIR SHORES, MI 48080
(586) 498-0440
1184673303 THOMAS PATRICK DAVIS MD
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
ST CLAIR SHORES, MI 48080
(586) 498-0440
1770515504 EDOUARD R. DAHER M.D.
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
SAINT CLAIR SHORES, MI 48080
(586) 498-0440
1306963335DR. DAVID JOSE RODRIGUEZ M.D.
Individual
Internal Medicine (Interventional Cardiology)24211 LITTLE MACK AVE
SAINT CLAIR SHORES, MI 48080
(586) 498-0440
1083902761 ZAID KASMIKHA D.O.
Individual
Internal Medicine (Cardiovascular Disease)24211 LITTLE MACK AVE
SAINT CLAIR SHORES, MI 48080
(586) 498-0440

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1790163962, enumerated in the NPI registry as an "individual" on May 08, 2015

The provider is located at 24211 Little Mack Ave Saint Clair Shores, Mi 48080 and the phone number is (586) 498-0440

The provider's speciality is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X

The provider has more than 11 years of experience. He graduated from Michigan State University College Of Osteopathic Medicine in 2015.

Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

The practitioner is affiliated to the following hospital(s): MCLAREN NORTHERN MICHIGAN. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on May 08, 2015. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.