DR. GLEN MIRANDILLA JACOB MD
NPI 1780757062
Internal Medicine in Largo, MD
About Dr. Glen Mirandilla Jacob Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. GLEN MIRANDILLA JACOB MD (NPI 1780757062) is an individual internal medicine provider in Largo, Maryland, licensed in Maryland (D59633) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1989).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Glen Mirandilla Jacob Md 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.
Medicare Billing Reassignment
Medicare enrollment records show Glen Jacob reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Suitland, MD 20746
- Reassigned Medicare billing, District of Columbia, Maryland and Virginia enrollments
- Also billed through NPI 1285752121 (Maryland), NPI 1972275196 (Virginia)
- 2,492 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.
Areas of Expertise CMS Part B claims 3
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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 20774 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Referred Medical Equipment & Supplies CMS DME claims
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LARGO, MD 20774
UPPER MARLBORO, MD 20774
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 Glen Jacob's NPI number?
The NPI number for Glen Jacob is 1780757062. It was assigned to this individual provider in the NPPES registry on November 16, 2006.
Where is Glen Jacob located?
Glen Jacob practices at 1221 Mercantile Lane, Largo, MD 20774. The listed phone number is (301) 618-5578.
What is Glen Jacob's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Glen Jacob enrolled in Medicare?
Yes. Glen Jacob 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.
Which organization bills Medicare for Glen Jacob's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Glen Jacob reassigns Medicare benefits to Kaiser Foundation Health Plan Of The Mid Atlantic States, Inc (Suitland, MD). 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 Glen Jacob's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Glen Jacob was last updated on February 23, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Dr. Glen Mirandilla Jacob, MD · NPI 1780757062
Internal Medicine physician in Largo, Maryland. Individual provider, active in the CMS NPPES registry since November 16, 2006.
## Identity
- **NPI:** 1780757062 (Entity type: Individual)
- **Enumerated:** November 16, 2006
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **State license:** D59633 (Maryland)
- **Sole proprietor:** No
## Practice location
- **Address:** 1221 MERCANTILE LANE, Largo, MD 20774-5374
- **Phone:** (301) 618-5578 · **Fax:** (301) 618-5673
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Kaiser Foundation Health Plan Of The Mid Atlantic States, Inc (NPI 1730200965, Suitland, MD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1989
## Record status
- **NPPES last updated:** February 23, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1780757062) · Data from the CMS NPPES public registry.