Jacob S. Form, D.P.M.
Podiatrist · Lafayette Hill, PA
Jacob S. Form, D.P.M. is a podiatrist with a practice address in Lafayette Hill, Pennsylvania, and NPI 1356367494, issued on Jul 14, 2006. Check the license (Pennsylvania SC002170L, as entered in NPPES) with the Pennsylvania board that licenses this profession; the Medicare figures below come from public CMS files.
- Name
- Jacob S. Form
- Credential
- D.P.M.
- Primary taxonomy
- Podiatrist 213E00000X
- License number
- SC002170L PA
Self-reported in NPPES; status is on the state search - Practice location
- 4129 Franklin Way, Lafayette Hill, PA 19444
- Phone
- (215) 292-2637
- Enumerated
- Jul 14, 2006
- Record last updated
- Apr 27, 2012 (not updated in 14 years: call before relying on the address or phone)
- Medicare enrollment
- Enrolled (PECOS I20070209000326); accepts Medicare assignment
- Medical or professional school
- Temple University School Of Podiatric Medicine, 1980
- Entity
- Type 1 · individual
8 nearest podiatrist records → All 689 in Pennsylvania → Look up another NPI →
Verify Jacob S. Form in five checks
- 1IdentityNPI record in CMS NPPESNPI lookupConfirmed in NPPES
- 2LicenseActive license and public ordersWhich Pennsylvania board licenses this profession
Search for license SC002170LCheck the board - 3Other statesLicenses and actions elsewhereDocInfo (FSMB)Not checked
- 4ExclusionsMedicare and Medicaid bansHHS-OIG exclusion listNot checked
- 5CertificationBoard certificationABMS AOA NCCPA AANPNot checked
The practice group's MIPS final score for 2023 (Medicare payment program): 76.9 of 100
The Merit-based Incentive Payment System score is reported for the practice group, not for one clinician alone. Four categories are weighted into the final score; the average among 454,083 clinicians with a measured score was 83.5.
Source: CMS Quality Payment Program, MIPS performance year 2023, group reporting; category weights for 2023 (qpp.cms.gov).
Jacob S. Form among 689 podiatrist records in Pennsylvania
Jacob S. Form, D.P.M. is one of 689 podiatrist records with a practice address in Pennsylvania. 65% of them appear in a Medicare file (Part D prescribing, MIPS, Open Payments or Medicare group billing); this one does. Its NPI, issued in 2006, is newer than 23% of them.
- NPI issued2006 · 23% of these records are older, 30% newer
- In a Medicare fileYes · 65% of these records are
- In the CMS Doctors and Clinicians fileYes · 57% of these records are
- Graduated1980 · median 1994 among the 390 with a school on file
- Record last updated2012 · 69% of these records were not updated in five years or more
Source: CMS NPPES, file of Aug 9, 2026, every record with primary taxonomy 213E00000X and a Pennsylvania practice address; Medicare files: CMS Part D Prescribers 2024, MIPS 2023, Open Payments 2024, Doctors and Clinicians (data.cms.gov).
Podiatrist providers in Pennsylvania
There are 689 podiatrist records in Pennsylvania.
All 689 in Pennsylvania → Every provider in Lafayette Hill → Podiatrist nationwide →
The 8 podiatrist records with the nearest ZIP codes
- Gregory Caringi, D.P.M.Lansdale, PA 194461336246206
- Arthur Donley, DPMLansdale, PA 194461194701763
- Rick Simon, DPMLansdale, PA 194461699793018
- Michael Drohosky, DPMPhoenixville, PA 194601871588905
- Robert Hanlon, D.P.M.Phoenixville, PA 194601346391729
- Hee KimPhoenixville, PA 194601154111003
- Warren Kofsky, DPMConshohocken, PA 194281568416675
- Howard Green, DPMPlymouth Meeting, PA 194621316052046
Common questions
What is Jacob S. Form, D.P.M.'s NPI number?
Jacob S. Form, D.P.M.'s National Provider Identifier (NPI) is 1356367494, issued on Jul 14, 2006. An NPI identifies a provider in billing; it is not a license.
Where is Jacob S. Form, D.P.M. located?
The NPPES record lists a practice address at 4129 Franklin Way, Lafayette Hill, PA, 19444. Phone: (215) 292-2637. Providers update this record themselves, so call before visiting.
How can I verify Jacob S. Form, D.P.M.'s license?
NPPES lists Pennsylvania license number SC002170L, as entered by the provider. Search the Pennsylvania board that licenses this profession; the NPPES record confirms identity only.
What is Jacob S. Form, D.P.M.'s MIPS final score?
The 2023 MIPS final score is 76.9 of 100, reported for the practice group. The average among 454,083 clinicians with a measured score was 83.5.
Source: CMS National Plan and Provider Enumeration System (NPPES), file of Aug 9, 2026 (NPPES files on CMS.gov); NUCC Health Care Provider Taxonomy. Medicare files from data.cms.gov. An NPI identifies who bills; it is not a license.
Figures on PlainDoctor are read from the federal files each page names (CMS NPPES, Medicare Part D, MIPS, Open Payments; the HHS-OIG exclusion list only as counts) and from Census population estimates, with the file date shown beside them. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error. Data current as of Aug 9, 2026.