Diane J Jacobi (NPI# 1912983560, PAC ID# 0042217168) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
Nation Provider ID (NPI) | 1912983560 |
PAC ID by PECOS | 0042217168 |
Professional Enrollment ID | I20061103000082 |
Full Name | Diane J Jacobi |
Organization Legal Name | SSM AUDRAIN HEALTH CARE INC |
Address |
1223 E Main St Ssm Health Medical Group Family Medicine Perry MO 63462-1410 |
Phone Number | 5735652213 |
Gender | F |
Credential | MD |
Medical School | UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE |
Graduation Year | 1993 |
Primary Specialty | FAMILY MEDICINE |
Group Practice PAC ID | 3678481827 |
Number of Group Practice Members | 38 |
Accepts Medicare Assignment | Y |
Claim Control Number (CCN) | Legal Business Name |
---|---|
260064 | SSM HEALTH ST. MARY'S HOSPITAL-AUDRAIN |
260068 | BOONE HOSPITAL CENTER |
Address | Phone | Organization |
---|---|---|
3626 S Clark St, Suite A, Mexico, MO 65265-4104 | 5735818590 | SSM AUDRAIN HEALTH CARE INC |
3626 S Clark St C, Mexico, MO 65265-4104 | 5735820850 | SSM AUDRAIN HEALTH CARE INC |
1223 E Main St, Ssm Health Medical Group Family Medicine, Perry, MO 63462-1410 | 5735652213 | SSM AUDRAIN HEALTH CARE INC |
Organization Legal Name | SSM AUDRAIN HEALTH CARE INC |
Physicians | 30 |
Name | Specialty | Organization | Address |
---|---|---|---|
Regina Hill | Nurse Practitioner | Ssm Audrain Health Care Inc | 3626 S Clark St C, Mexico, MO 65265-4104 |
Nathan W Skelley | Orthopedic Surgery | Ssm Audrain Health Care Inc | 515 E Promenade, Ssm Health Medical Group Orthopedic Surgery, Mexico, MO 65265-2966 |
Jeffrey T Vacek | Nurse Practitioner | Ssm Audrain Health Care Inc | 1223 E Main St, Ssm Health Medical Group Family Medicine, Perry, MO 63462-1410 |
Nathan T Kenyon | Physical Medicine and Rehabilitation | Ssm Audrain Health Care Inc | 515 E Promenade St, Ssm Health Med Group, Mexico, MO 65265-2966 |
Kristina M Boylan | Nurse Practitioner | Ssm Audrain Health Care Inc | 240 Pickering St, Montgomery City, MO 63361-1941 |
Rebecca Kelley | Family Medicine | Ssm Audrain Health Care Inc | 201 S Main St, Ssm Health Med Grp Fam Medicine, Auxvasse, MO 65231-1624 |
Eric F Kondro | Internal Medicine | Ssm Audrain Health Care Inc | 111 W Bates St, Ssm Health Medical Group Family Medicine, Wellsville, MO 63384-1616 |
Michael L Quinlan | Internal Medicine | Ssm Audrain Health Care Inc | 600 Medical Park Dr, Mexico, MO 65265-3724 |
Simon Mckeown | Family Medicine | Ssm Audrain Health Care Inc | 350 Country Meadow Ln, Fulton, MO 65251-5278 |
Michael T Kinkade | Family Medicine | Ssm Audrain Health Care Inc | 204 W Washington St, Vandalia, MO 63382-1473 |
Street Address |
1223 E MAIN ST SSM HEALTH MEDICAL GROUP FAMILY MEDICINE |
City | PERRY |
State | MO |
Zip | 63462-1410 |
Name | Specialty | Organization | Address |
---|---|---|---|
Jeffrey T Vacek | Nurse Practitioner | Ssm Audrain Health Care Inc | 1223 E Main St, Ssm Health Medical Group Family Medicine, Perry, MO 63462-1410 |
City | PERRY |
Zip Code | 63462 |
Specialty | FAMILY MEDICINE |
City + Specialty | PERRY + FAMILY MEDICINE |
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Data Provider | Centers for Medicare & Medicaid Services (CMS) |
Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.