ANNETTE L JACOB (LICSW) – Clinical Social Worker, NPI 1174629869
Clinical Social Worker
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,310 CLINICAL SOCIAL WORKER in MN
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Provider Addresses for ANNETTE L JACOB (LICSW)
2338, West Doswell Avenue, North Saint Anthony Park, Saint Anthony Park, Saint Paul, Ramsey County, Minnesota, 55108, United States
SAINT PAUL, MN 551081631
Phone: (651) 647-1900
Type: Mailing
Egg & I, 2550, University Avenue West, Saint Paul, Ramsey County, Minnesota, 55114, United States
SUITE 435S
SAINT PAUL, MN 551141052
Phone: (651) 647-1900
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: 2006-03-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20060302000620 | I | Clinical Social Worker | MN | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 90834 | Psychotherapy, 45 minutes | 122 | 14 | $0 |
Insurance plans in this area (ZIP 55108)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Mental Health Counselor | MN | |
| Mental Health Counselor | MN | |
| - | MN | |
| Clinical Psychologist | MN | |
| Clinical Psychologist | MN | |
| Mental Health Counselor | MN | |
| Marriage And Family Therapist | MN | |
| - | MN | |
| - | MN | |
| Clinical Social Worker | MN |
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