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NAOMI T. JACOBS, PH.D., P.A.
NPI 1184996704
Psychologist - Clinical in Ponte Vedra Beach, FL

Active since January 27, 2012
100 EXECUTIVE WAY, SUITE 207, PONTE VEDRA BEACH, FL 32082(904) 687-6336 Get Directions Write a Review

NPPES record last updated: September 17, 2013. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Naomi T. Jacobs, Ph.d., P.a. NPPES

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

NAOMI T. JACOBS, PH.D., P.A. (NPI 1184996704) is a healthcare organization registered as a clinical in Ponte Vedra Beach, Florida and active in the NPI registry since January 2012. The organization lists Naomi Jacobs, Psychologist, as its authorized official.

NPPES Registry Identity

NPI1184996704
Entity TypeOrganization
Primary Taxonomy103TC0700X
Legal Business NameNAOMI T. JACOBS, PH.D., P.A.
Location Address100 EXECUTIVE WAY, SUITE 207Ponte Vedra Beach, FL 32082-2715
Mailing Address100 Executive Way, Suite 207Ponte Vedra Beach, FL 32082-2715 · (904) 687-6336
Phone(904) 687-6336
Organization SubpartNo
Authorized OfficialNaomi JacobsPsychologist · (904) 687-6336
Enumeration DateJanuary 27, 2012
Last NPPES UpdateSeptember 17, 2013
✔ NPI 1184996704 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
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.
100 EXECUTIVE WAY, Ponte Vedra Beach, FL 32082
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Naomi T. Jacobs, Ph.d., P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateFloridaEnrollment IDO20120404000104Non-DME Part B · Clinic/Group PracticeDue dateNovember 30, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Naomi T. Jacobs, Ph.D., P.A., which bills Medicare for the services this clinician delivers.

Clinician (1)

Naomi Jacobs, PH.D.
Clinical Psychologist
NPI 1275641110
100 EXECUTIVE WAY SUITE 207
Ponte Vedra Beach, FL 32082
(904) 687-6336
✔ PECOS✔ Accepts MedicareSame address

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

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 Naomi T. Jacobs, Ph.D., P.A.'s NPI number?

The NPI number for Naomi T. Jacobs, Ph.D., P.A. is 1184996704. It was assigned to this organization in the NPPES registry on January 27, 2012.

Where is Naomi T. Jacobs, Ph.D., P.A. located?

Naomi T. Jacobs, Ph.D., P.A. is located at 100 Executive Way Suite 207, Ponte Vedra Beach, FL 32082. The listed phone number is (904) 687-6336.

What is Naomi T. Jacobs, Ph.D., P.A.'s specialty?

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

Is Naomi T. Jacobs, Ph.D., P.A. enrolled in Medicare?

Yes. Naomi T. Jacobs, Ph.D., P.A. is registered in the Medicare PECOS enrollment system.

When is Naomi T. Jacobs, Ph.D., P.A.'s Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Florida, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Naomi T. Jacobs, Ph.D., P.A.?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Naomi T. Jacobs, Ph.D., P.A.. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Naomi T. Jacobs, Ph.D., P.A. was last updated on September 17, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.