DR. JACOB L MOSKOVIC, M.D. - NPI NUMBER 1205863792

Summary

Provider Name: DR. JACOB L MOSKOVIC, M.D.

NPI Number: 1205863792

Clasification: Psychiatry & Neurology (2084P0802X)

Specialization: Addiction Psychiatry

Organization: JACOB L. MOSKOVIC, M.D. S.C.

Address:
120 W EASTMAN ST
SUITE 202
ARLINGTON HEIGHTS, IL
ZIP 60004

Phone Number: (847) 590-0050



Detailed Information

DR. Jacob L Moskovic, M.D. is an addiction psychiatrist in Arlington Heights, IL with 53 years of experience. The provider is addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. The assigned NPI number for this provider is 1205863792 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

120 W EASTMAN ST
SUITE 202
ARLINGTON HEIGHTS, IL
ZIP 60004-937
Phone: (847) 590-0050
Fax: (847) 590-0080

The enumeration date for this NPI number is 6/28/2006 and was last updated on 12/6/2010.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 2084P0802X Psychiatry & Neurology Addiction Psychiatry 036-040989 IL No
2 2084P0805X Psychiatry & Neurology Geriatric Psychiatry 036-040989 IL No
3 2084P0800X Psychiatry & Neurology Psychiatry 036-040989 IL Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 C41372 MEDICARE UPIN IL
2 458920 MEDICARE ID-TYPE UNSPECIFIED IL
3 36040989 MEDICAID IL

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1205863792 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
3 Provider Last Name Legal Name MOSKOVIC The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name JACOB The first name of the provider, if the provider is an individual.
5 Provider Middle Name L The middle name of the provider, if the provider is an individual.
6 Provider Name Prefix Text DR. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
7 Provider Credential Text M.D. The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider First Line Business Practice Location Address 120 W EASTMAN ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Second Line Business Practice Location Address SUITE 202 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
10 Provider Business Practice Location Address City Name ARLINGTON HEIGHTS The city name in the location address of the provider being identified.
11 Provider Business Practice Location Address State Name IL The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Postal Code 600045937 The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
14 Provider Business Practice Location Address Telephone Number 8475900050 The country code in the location address of the provider being identified.
15 Provider Business Practice Location Address Fax Number 8475900080 The fax number associated with the location address of the provider being identified.
16 Provider Enumeration Date 6/28/2006 The fax number associated with the location address of the provider being identified.
17 Last Update Date 12/6/2010 The date that a record was last updated or changed.
18 Provider Gender Code M The code designating the provider’s gender if the provider is a person.
19 Healthcare Provider Taxonomy Code 1 2084P0802X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Provider License Number 1 036-040989 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
21 Provider License Number State Code 1 IL The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
22 Healthcare Provider Primary Taxonomy Switch 1 N
23 Healthcare Provider Taxonomy Code 2 2084P0805X Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Provider License Number 2 036-040989 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
25 Provider License Number State Code 2 IL The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
26 Healthcare Provider Primary Taxonomy Switch 2 N
27 Healthcare Provider Taxonomy Code 3 2084P0800X
28 Provider License Number 3 036-040989 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
29 Provider License Number State Code 3 IL The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
30 Healthcare Provider Primary Taxonomy Switch 3 Y
31 Other Provider Identifier 1 C41372 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
32 Other Provider Identifier Type Code 1 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
33 Other Provider Identifier State 1 IL
34 Other Provider Identifier 2 458920 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
35 Other Provider Identifier Type Code 2 04 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
36 Other Provider Identifier State 2 IL
37 Other Provider Identifier 3 36040989 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
38 Other Provider Identifier Type Code 3 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
39 Other Provider Identifier State 3 IL
40 Is Sole Proprietor Y Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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