MR. MICHAEL BLAKE JACOB (NPI# 1821502154) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821502154 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL BLAKE JACOB |
| Credential | PA-C |
| Practice Address |
2855 Campus Dr Plymouth MN 55441-2649 |
| Mailing Address |
5600 Camerata Way Unit 221 St Louis Park MN 55416-5285 |
| Practice Telephone | 7635777000 |
| Mailing Telephone | 6125903809 |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2018-11-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
12595 | MN | Allopathic & Osteopathic Physicians |
| Y | 363A00000X | Physician Assistant | 12593 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 800 E 28th St, Minneapolis, MN 554073723 | 6128634000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861965816 | Michael Jacob | Counselor | 415 E Madison St, South Bend, IN 46617-2322 | 2019-01-02 |
| 1184966582 | Michael Simon Jacob | Psychiatry & Neurology | 4150 Clement St, San Francisco, CA 94121-1563 | 2013-03-23 |
| 1841374253 | Michael Jacob | Physical Therapist | 430 Kele St, Ste 401, Kahului, HI 96732-3406 | 2006-10-24 |
| 1508824905 | Michael D Jacob | Nurse Anesthetist, Certified Registered | 7150 Clearvista Drive, Indianapolis, IN 37043 | 2006-05-03 |
| Street Address |
2855 CAMPUS DR |
| City | PLYMOUTH |
| State | MN |
| Zip Code | 55441-2649 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639171820 | Terry W. Hood | Neurological Surgery | 2855 Campus Dr, Ste 570, Plymouth, MN 55441-2660 | 2005-06-01 |
| 1891309092 | Bridget Pauline Williams | Pharmacist | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2020-09-04 |
| 1093277238 | Megan Hickenbottom | Social Worker | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2019-04-05 |
| 1831670470 | Stephanie Michelle Walek | Pharmacist | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2018-08-22 |
| 1457741092 | Narges Golgol | Physician Assistant | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2015-02-04 |
| 1295131357 | Eva Gabriela Martinez | Physical Therapist | 2855 Campus Dr, Suite 650, Plymouth, MN 55441-2649 | 2014-11-17 |
| 1336495068 | Allina Health System | Clinic/Center | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2012-07-31 |
| 1477828515 | Vedavathi Ramesh Bellamkonda-athmaram | Pediatrics | 2855 Campus Dr, #350, Plymouth, MN 55441-2649 | 2012-03-21 |
| 1568739043 | Allina Health System | Clinic/Center | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2011-11-28 |
| 1831466317 | Allina Health System | Clinic/Center | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2011-11-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689190019 | The Recovery Clinic LLC | Clinic/Center | 9800 Shelard Pkwy Ste 215, Plymouth, MN 55441 | 2017-08-17 |
| 1356887186 | Katherine Marlow Bell | Dentist | 2805 Campus Dr Ste 245, Plymouth, MN 55441 | 2017-01-18 |
| 1083069538 | Mercade Waldon | Home Health Aide | 3501 Xenium Lane, Plymouth, MN 55441 | 2016-05-03 |
| 1346645538 | Phs Westhealth, Inc | Skilled Nursing Facility | 2775 Campus Drive North, Plymouth, MN 55441 | 2014-10-30 |
| 1427453125 | Samuel David Fine | Pharmacist | 4070 Goldenrod Ln, Plymouth, MN 55441 | 2014-10-24 |
| 1548672538 | Scott Aaron Schmidt | Dentist | 2720 Annapolis Circle N, Suite A, Plymouth, MN 55441 | 2014-05-23 |
| 1831498633 | Comforide Transportation Services LLC | Non-emergency Medical Transport (VAN) | 9730 37th Pl N Suite 201, Plymouth, MN 55441 | 2011-03-18 |
| 1255669271 | Tammy Kae Mehlhaus | Physician Assistant | 2855 Campus Drive, Suite 570, Plymouth, MN 55441 | 2009-12-02 |
| 1164758199 | Stephen P. Boger, Dds, Pa | Dentist | 2720 Annapolis Circle, Suite A, Plymouth, MN 55441 | 2009-10-27 |
| 1093908360 | Endodontic Professionals Pa Plymouth Endodontics | Dentist | 3401 Hwy 169 N, Plymouth, MN 55441 | 2007-08-21 |
| Find all providers in zip 55441 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942827852 | Lisa Marie Mcmullen | Physician Assistant | 11845 Pine Way Ct, Plymouth, MI 48170-6299 | 2020-06-26 |
| 1427679703 | Maura Jean Walsh Clemons | Physician Assistant | 12015 26th Ave N, Plymouth, MN 55441-2903 | 2020-04-28 |
| 1457912842 | Joseph Andrew Flagg | Physician Assistant | 35 Kirk Cir, Plymouth, MA 02360-2372 | 2019-06-26 |
| 1780154419 | Allina Health System | Physician Assistant | 16725 County Road 24, Plymouth, MN 55447-1289 | 2018-11-26 |
| 1023585221 | Christopher Rowley | Physician Assistant | 3655 Plymouth Blvd Ste 100, Plymouth, MN 55446-3665 | 2018-10-26 |
| 1407331440 | Mia Catherine Scagliarini | Physician Assistant | 110 Long Pond Rd Ste 212, Plymouth, MA 02360-2642 | 2018-09-25 |
| 1700235868 | Joanna Van Doren | Physician Assistant | 345 Court St Ste 201, Plymouth, MA 02360-4329 | 2016-06-09 |
| 1588903009 | Laura Davidson | Physician Assistant | 3365 Plymouth Blvd., Suite 110, Plymouth, MN 55446 | 2013-02-04 |
| 1891081626 | Peter Andrew Shannon | Physician Assistant | 41424 Ann Arbor Rd E, Plymouth, MI 48170-8005 | 2011-06-20 |
| 1255669271 | Tammy Kae Mehlhaus | Physician Assistant | 2855 Campus Drive, Suite 570, Plymouth, MN 55441 | 2009-12-02 |
| Find all providers in PLYMOUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.