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DR. JACOB S. FORM D.P.M.
NPI 1356367494
Podiatrist in Lafayette Hill, PA

Active since July 14, 2006PECOS EnrolledAccepts Medicare Assignment
76.89/100
CMS Quality Rating
4129 FRANKLIN WAY, LAFAYETTE HILL, PA 19444(215) 292-2637 Get Directions Write a Review

NPPES record last updated: April 27, 2012. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Dr. Jacob S. Form D.p.m. NPPES

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

DR. JACOB S. FORM D.P.M. (NPI 1356367494) is an individual podiatrist in Lafayette Hill, Pennsylvania, licensed in Pennsylvania (SC002170L) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS and is a graduate of Temple University School Of Podiatric Medicine (1980).

NPPES Registry Identity

NPI1356367494
Entity TypeIndividualMale
Primary Taxonomy213E00000X
Provider Legal NameDR. JACOB S. FORMCredential: D.P.M.
Location Address4129 FRANKLIN WAYLafayette Hill, PA 19444-1300
Mailing Address4129 Franklin WayLafayette Hill, PA 19444-1300 · (215) 292-2637
Phone(215) 292-2637
Sole ProprietorYes
Medical School CMSTemple University School Of Podiatric MedicineGraduated 1980
Enumeration DateJuly 14, 2006
Last NPPES UpdateApril 27, 2012
✔ NPI 1356367494 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatristPodiatric Medicine & Surgery Service Providers
Taxonomy Code213E00000X
License✔ Licensed in PA · SC002170L
Definition
A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.
4129 FRANKLIN WAY, Lafayette Hill, PA 19444
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Other Identifiers 8

Other0048261000PA · Blue Cross Hmo
Other33473PA · Health Partners
Other1000746PA · Keystone Mercy
Other000159517PA · Blue Shield
Other10766PA · Elder Health
Medicare UPINT29772PA
Medicare ID-Type Unspecified159517PA
Other0080982301PA · Americhoice

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Jacob S. Form D.p.m. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7911909643
PECOS Enrollment IDI20070209000326
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.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Removal of fingernails or toenails, 6 or more nails 11721
This procedure involves the removal of six or more fingernails or toenails. It's typically done to treat severe nail infections, persistent pain, or abnormal nail growth. Local anesthesia is used to minimize discomfort. Healing usually takes a few weeks.
1,498 services446 patients
Removal of fingernails or toenails, 1-5 nails 11720
This procedure involves the careful removal of 1-5 nails from fingers or toes. It's typically done to treat conditions like ingrown nails, fungal infections, or damaged nails. Local anesthesia is used for comfort, and the area heals over time with appropriate care.
233 services81 patients
Removal of noncancer thickened skin growth, 2-4 growths 11056
This procedure involves the safe removal of 2-4 noncancerous thickened skin growths. It's typically done under local anesthesia. The process helps to alleviate discomfort and prevent potential complications. It's a standard, low-risk procedure.
117 services49 patients
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308
A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
101 services101 patients
Removal of noncancer thickened skin growth, 1 growth 11055
This procedure involves the removal of a thickened skin growth that is not cancerous. A healthcare professional will safely extract the growth, usually under local anesthesia. This process helps maintain skin health and prevent potential complications.
100 services55 patients
Removal of fingernails or toenails, 6 or more nails 11721
This procedure involves the removal of six or more fingernails or toenails. It's typically done to treat severe nail infections, persistent pain, or abnormal nail growth. Local anesthesia is used to minimize discomfort. Healing usually takes a few weeks.
72 services34 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19444 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
$92.69 typical visit price
range $59.88 – $180.99
Typical copayment $23.17 (range $14.97 – $45.24)
Most-billed visit code 99203
Established Patient
$74.47 typical visit price
range $19.30 – $147.29
Typical copayment $18.61 (range $4.82 – $36.82)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

76.89/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality43.63
Promoting Interoperability93
Improvement Activities40

Reported Quality Measures

Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
42%2,506 patients2/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

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 Jacob Form's NPI number?

The NPI number for Jacob Form is 1356367494. It was assigned to this individual provider in the NPPES registry on July 14, 2006.

Where is Jacob Form located?

Jacob Form practices at 4129 Franklin Way, Lafayette Hill, PA 19444. The listed phone number is (215) 292-2637.

What is Jacob Form's specialty?

The primary specialty registered for this NPI is Podiatrist with taxonomy code 213E00000X.

Is Jacob Form enrolled in Medicare?

Yes. Jacob Form is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Jacob Form accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Buckeye Health Plan list Jacob Form 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 Jacob Form was last updated on April 27, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.