Jacob Form, D.P.M.
NPI 1356367494 · Podiatrist · Lafayette Hill, PA
Enrolled with Medicare as Practitioner - Podiatry · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1356367494
- Entity type
- Individual
- Primary specialty
- PodiatristPodiatric Medicine & Surgery Service Providers
- Credential
- D.P.M.
- Sex
- Male
- Sole proprietor
- Yes
- License
- SC002170L (PA)
Specialties & taxonomies
Podiatric Medicine & Surgery Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure28% of score
19 yrs in NPPES registry
- Profile completeness28% of score
100% of core fields populated
- Practice footprint17% of score
1 documented practice location
- Medicare service volume (vs. specialty peers)28% of score
2,244 Medicare services, 2024 (ranked within specialty)
Medicare volume is ranked against active providers in the same specialty. Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
What this provider does (Medicare)
Based on Medicare fee-for-service claims, 2024; not all care is captured.
| Service (HCPCS) | Medicare services | Typical Medicare-allowed (2024) |
|---|---|---|
| Removal of Fingernails Or Toenails, 6 Or More Nails11721 | 1,498 | $46 |
| Removal of Fingernails Or Toenails, 1-5 Nails11720 | 233 | $34 |
| Removal of Noncancer Thickened Skin Growth, 2-4 Growths11056 | 117 | $72 |
| Subsequent Nursing Facility Care With Straightforward Level of Medical Decision Making, Per Day, If Using Time, 20 Minutes Or More99308 | 101 | $74 |
| Removal of Noncancer Thickened Skin Growth, 1 Growth11055 | 100 | $56 |
| Removal of Fingernails Or Toenails, 6 Or More Nails11721 | 72 | $24 |
Practice location
Mailing address
Registry dates
- Enumerated
- 2006-07-14
- Last updated
- 2012-04-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.