Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jacob Waxman, MD

Individual provider Diagnostic Radiology Physician · NPI 1972946937

Jacob Waxman, MD is a Diagnostic Radiology in Roseville, Minnesota. Qualified in 2013, 13 years ago. Practices with Grand Itasca Clinic and Hospital, a 325-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
13
Licensed in
MN
In the registry since
2013
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2355 Highway 36 W Ste 100
Roseville, MN 55113-3905
Phone: (651) 292-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 200 1st St Sw, Rochester, MN 55905 — (507) 293-3680

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 58490 (MN)

Record details

NPI number1972946937
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 9, 2013
Last updated in NPPESJuly 22, 2021
Certification dateJuly 22, 2021
Mailing address2355 Highway 36 W Ste 100, Roseville, MN 55113-3905

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Grand Itasca Clinic And Hospital — 325 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations21 on file with Medicare

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