DR. SCOTT MICHAEL JACOBY PH.D.
NPI 1073826913
Psychologist - Clinical in Minneapolis, MN

Q: What is Scott Jacoby's NPI number?

The NPI number for Scott Jacoby is 1073826913. It was assigned to this individual provider in the NPPES registry on July 20, 2010.

Q: What is Scott Jacoby's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Scott Jacoby was last updated on July 20, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 20, 2010PECOS Enrolled

2110 LYNDALE AVE S, MINNEAPOLIS, MN 55405(952) 353-5931 Get Directions Write a Review

NPPES record last updated: July 20, 2010. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Dr. Scott Michael Jacoby Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SCOTT MICHAEL JACOBY PH.D. (NPI 1073826913) is an individual clinical provider in Minneapolis, Minnesota, licensed in Minnesota (5269) and active in the NPI registry since July 2010. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1073826913

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameDR. SCOTT MICHAEL JACOBYCredential: PH.D.

Location Address2110 LYNDALE AVE SMinneapolis, MN 55405-3196

Mailing Address935 Winslow AveWest St Paul, MN 55118-1340 · (612) 669-3430

Phone(952) 353-5931

Sole ProprietorNo

Enumeration DateJuly 20, 2010

✔ NPI 1073826913 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in MN · 5269

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Also ListedPsychologist · Cognitive & BehavioralTaxonomy 103TB0200X · License 5269 (MN)

Also ListedPsychologist · Group PsychotherapyTaxonomy 103TP2701X · License 5269 (MN)

2110 LYNDALE AVE S, Minneapolis, MN 55405

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Scott Michael Jacoby Ph.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Scott Jacoby reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Birch Counseling, PLLC.

8.8 mi

Mental Health (Including Community Mental Health Center)

12800 WHITEWATER DR # 310
Minnetonka, MN 55343

Reassigned Medicare billing, Minnesota enrollment
6 clinicians in this Medicare group

NPI 1598186330 (866) 244-2472

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55405 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$168.28 typical visit price

range $56.00 – $168.28

Typical copayment $42.07 (range $14.00 – $42.07)

Most-billed visit code 99205

Established Patient

$98.61 typical visit price

range $18.32 – $138.04

Typical copayment $24.65 (range $4.58 – $34.51)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RYAN ALAN PETROS LICSW

Social Worker (Clinical)

2110 LYNDALE AVE S
MINNEAPOLIS, MN 55405

Hennepin County (612) 825-8714

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Scott Jacoby's NPI number?

The NPI number for Scott Jacoby is 1073826913. It was assigned to this individual provider in the NPPES registry on July 20, 2010.

Where is Scott Jacoby located?

Scott Jacoby practices at 2110 Lyndale Ave S, Minneapolis, MN 55405. The listed phone number is (952) 353-5931.

What is Scott Jacoby's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Scott Jacoby enrolled in Medicare?

Yes. Scott Jacoby is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Scott Jacoby's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Scott Jacoby reassigns Medicare benefits to Birch Counseling, PLLC. (Minnetonka, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Scott Jacoby's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Scott Jacoby accept?

Health plans from HealthPartners list Scott Jacoby as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Scott Jacoby was last updated on July 20, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.