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1033591086

NPI Code Detail

MEDICARE: JACOB SHOPP MD

MEDICARE: JACOB SHOPP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MD488539	PA
2	207P00000X	Emergency Medicine Physician	EMC0005365	MI
3	207P00000X	Emergency Medicine Physician	77341	MN
4	207P00000X	Emergency Medicine Physician	C2899	KY
5	207P00000X	Emergency Medicine Physician	01079961A	IN
6	207P00000X	Emergency Medicine Physician	036.170829	IL
7	390200000X	Student in an Organized Health Care Education/Training Program
8	207P00000X	Emergency Medicine Physician	ME158432	FL
9	207P00000X	Emergency Medicine Physician	MD-53386	IA
10	207P00000X	Emergency Medicine Physician	4584-320	WI

General Provider Information

NPI Number	:	1033591086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB SHOPP MD

Provider Business Mailing Address
First Line	:	10475 CROSSPOINT BLVD STE 250
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3387
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10475 CROSSPOINT BLVD STE 250
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3387
Country	:	US
Telephone Number	:	657-237-2450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	10/21/2025

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Directions to “ JACOB SHOPP MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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