MICHAEL JACOB
NPI 1336907575
Counselor - Mental Health in Saint Cloud, MN
About Michael Jacob NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MICHAEL JACOB (NPI 1336907575) is an individual mental health provider in Saint Cloud, Minnesota, licensed in Minnesota (4331) and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS and is a graduate of Other (2021).
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Michael Jacob is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Michael Jacob reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Edina, MN 55439
- Reassigned Medicare billing, Minnesota enrollment
- Medicare enrollment name: Affinity Psychological Services PC
- 136 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 4
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Michael Jacob's NPI number?
The NPI number for Michael Jacob is 1336907575. It was assigned to this individual provider in the NPPES registry on March 12, 2024.
Where is Michael Jacob located?
Michael Jacob practices at 3400 1st St N Ste 101, Saint Cloud, MN 56303. The listed phone number is (612) 268-5858.
What is Michael Jacob's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Michael Jacob enrolled in Medicare?
Yes. Michael Jacob is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Michael Jacob's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Michael Jacob reassigns Medicare benefits to Affinity Psychological Services, P.C. (Edina, 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 Michael Jacob's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Michael Jacob accept?
Health plans from HealthPartners list Michael Jacob 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 Michael Jacob was last updated on October 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Michael Jacob · NPI 1336907575
Mental Health provider in Saint Cloud, Minnesota. Individual provider, active in the CMS NPPES registry since March 12, 2024.
## Identity
- **NPI:** 1336907575 (Entity type: Individual)
- **Enumerated:** March 12, 2024
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **State license:** 4331 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 3400 1ST ST N STE 101, Saint Cloud, MN 56303-1924
- **Phone:** (612) 268-5858
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Affinity Psychological Services, P.C. (NPI 1245610856, Edina, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** October 3, 2024
---
Source: [NPI Profile](https://npiprofile.com/npi/1336907575) · Data from the CMS NPPES public registry.