CLYDE TYRONE III JACOB (M.D.) – Obstetrics & Gynecology Physician, NPI 1972504488
Obstetrics & Gynecology Physician
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Profile Insights
NPPES metrics only — not quality of care.
1,266 OBSTETRICS/GYNECOLOGY in GA
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Provider Addresses for CLYDE TYRONE III JACOB (M.D.)
5950 CABOTAGE RD
DULUTH, GA 300978475
Phone: (908) 397-2019
Type: Mailing
Emory Johns Creek Hospital, 6325, Hospital Parkway, Johns Creek, Georgia, 30097, United States
JOHNS CREEK, GA 300975775
Phone: (678) 474-7000
Type: Location
595, Ashwood Road, Springfield, Union County, New Jersey, 07081, United States
SPRINGFIELD, NJ 070812528
Phone: (908) 397-2019
Type: Mailing
3950 Austell Rd
Austell, GA 301061121
Phone: (770) 793-5913
Fax: (770) 999-2445
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2026-01-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 7 Medicare enrollment records; no due dates published yet.
Enrollment records
7
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20150105000359 | I | Obstetrics/Gynecology | NJ | TBD |
| I20181108001950 | I | Obstetrics/Gynecology | GA | TBD |
| I20230503000319 | I | Obstetrics/Gynecology | DE | TBD |
| I20230828001470 | I | Obstetrics/Gynecology | FL | TBD |
| I20240812000163 | I | Obstetrics/Gynecology | WA | TBD |
| I20250707001386 | I | Obstetrics/Gynecology | AR | TBD |
| I20260129003580 | I | Obstetrics/Gynecology | MD | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30097)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O B S T E T R I C S/ G Y N E C O L O G Y | FL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | FL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | FL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | FL | |
| Undersea And Hyperbaric Medicine, Preventive Medicine, Obstetrics/Gynecology | IN | |
| O B S T E T R I C S/ G Y N E C O L O G Y | TX | |
| O B S T E T R I C S/ G Y N E C O L O G Y | GA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | FL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | FL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | FL |
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