Clyde Tyrone Jacob Iii, MD in Johns Creek, GA - Medicare Obstetrics & Gynecology

Clyde Tyrone Jacob Iii, MD is a medicare enrolled "Obstetrics & Gynecology" physician in Johns Creek, Georgia. His current practice location is 6325 Hospital Pkwy, Johns Creek, Georgia. You can reach out to his office (for appointments etc.) via phone at (678) 474-7000.

Clyde Tyrone Jacob Iii is licensed to practice in Georgia (license number 81399) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1972504488.

Contact Information

	Clyde Tyrone Jacob Iii, MD
	6325 Hospital Pkwy, Johns Creek, GA 30097-5775
	(678) 474-7000
	Not Available

Map and Direction

Physician's Profile

Full Name	Clyde Tyrone Jacob Iii
Gender	Male
Speciality	Obstetrics & Gynecology
Location	6325 Hospital Pkwy, Johns Creek, Georgia
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1972504488
Provider Enumeration Date: 08/09/2005
Last Update Date: 12/14/2023

Medicare PECOS Information:

PECOS PAC ID: 0648373365
Enrollment ID: I20150105000359

Medical Identifiers

Medical identifiers for Clyde Tyrone Jacob Iii such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1972504488	NPI	-	NPPES
02219496	Medicaid	NY

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207V00000X	Obstetrics & Gynecology	01089636A (Indiana)	Secondary
207V00000X	Obstetrics & Gynecology	1999591 (New York)	Secondary
207V00000X	Obstetrics & Gynecology	ME162114 (Florida)	Secondary
207V00000X	Obstetrics & Gynecology	C1-0025884 (Delaware)	Secondary
207V00000X	Obstetrics & Gynecology	25MA09347700 (New Jersey)	Secondary
207V00000X	Obstetrics & Gynecology	81399 (Georgia)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Clyde Tyrone Jacob Iii allows following entities to bill medicare on his behalf.

Entity Name	Dhp Of New Jersey Pa
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1275896516 PECOS PAC ID: 8820247844 Enrollment ID: O20121009000081

Entity Name	Dhp Of Princeton Pa
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1912463498 PECOS PAC ID: 8224364237 Enrollment ID: O20190730000603

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Clyde Tyrone Jacob Iii is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Clyde Tyrone Jacob Iii, MD 5950 Cabotage Rd, Duluth, GA 30097-8475 Ph: (908) 397-2019	Clyde Tyrone Jacob Iii, MD 6325 Hospital Pkwy, Johns Creek, GA 30097-5775 Ph: (678) 474-7000

Reviews and Comments

Obstetrics & Gynecology Doctors in Johns Creek, GA

Mrs. Padmavathi V. Pagadala, M.D. Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 12000 Findley Rd Ste 400, Johns Creek, GA 30097 Phone: 404-778-3401 Fax: 770-495-2304
Dr. Jennifer Lynn Narvaez Roberts, MD Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 6335 Hospital Pkwy Ste 502, Johns Creek, GA 30097 Phone: 404-778-3401
Miss Tina Marie Mason, MD Obstetrics & Gynecology Medicare: Medicare Enrolled Practice Location: 6300 Hospital Pkwy, Suite 200, Johns Creek, GA 30097 Phone: 678-985-5800 Fax: 678-376-5848
Xiaoyin Tina Lu, MD Obstetrics & Gynecology Medicare: Not Enrolled in Medicare Practice Location: 10692 Medlock Bridge Rd Ste 100a, Johns Creek, GA 30097 Phone: 404-446-2492
Jana Platz Keating, MD Obstetrics & Gynecology Medicare: Medicare Enrolled Practice Location: 6335 Hospital Pkwy Ste 502, Johns Creek, GA 30097 Phone: 404-778-3401
Zin Htet Alonso, MD, MPH Obstetrics & Gynecology Medicare: Medicare Enrolled Practice Location: 10692 Medlock Bridge Rd Ste 100a, Johns Creek, GA 30097 Phone: 404-446-2496
Dr. Ingrid Vivian Reyes, M.D. Obstetrics & Gynecology Medicare: Not Enrolled in Medicare Practice Location: 10692 Medlock Bridge Rd Ste 100a, Johns Creek, GA 30097 Phone: 404-446-2496 Fax: 404-446-2497

Clyde Tyrone Jacob Iii, MD - Medicare Obstetrics & Gynecology in Johns Creek, GA