Individual provider Active NPI

Adeeb Yacoub, M.D.

  • Psychiatry Physician
  • New York, NY
National Provider Identifier
1013938828
Registry record updated May 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
220585 Issued in NY
Practice address
109 W 27TH St Ste 5S
New York, NY 10001-6208
Phone
(833) 351-8255
NPI assigned
Jul 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 178589 CA
Psychiatry Physician 2084P0800X 220585 NY Primary

Addresses

Primary practice location

109 W 27TH St Ste 5S
New York, NY 10001-6208

Mailing address

109 W 27TH St RM 5S
New York, NY 10001-6208
Phone (833) 351-8255

Other practice location 1

400 Union Ave SE Ste 200
Olympia, WA 98501-2060
Phone (833) 351-8255

Other practice location 2

100 Pine St Ste 1250
San Francisco, CA 94111-5235
Phone (833) 351-8255

Other practice location 3

4435 E Chandler Blvd Ste 200
Phoenix, AZ 85048-7651
Phone (833) 351-8255

Other identifiers 2

IdentifierTypeStateIssuer
02171864MedicaidNY
7711407OtherNYAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CA, AZ, WA4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20101018000631 NY Practitioner - Psychiatry 9032302500 Reassigns benefits to 1 organization
I20231010000834 CA Practitioner - Psychiatry 9032302500 Reassigns benefits to 1 organization
I20231208002280 AZ Practitioner - Psychiatry 9032302500 Reassigns benefits to 1 organization
I20231211002144 WA Practitioner - Psychiatry 9032302500 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MCCD Ca Psychiatry Services PCGroup PAC ID 9931564267, 45 clinicians

Practice addresses (Care Compare)

100 Pine St
Suite 1250
San Francisco, CA 94111-5235
Phone (833) 351-8255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
MCCD Ca Psychiatry Services PC Psychiatry CurrentSince Oct 1, 2023 Accepting new patients
MCCD FL Psychiatry Services PA Psychiatry CurrentSince Oct 28, 2023 Accepting new patients
MCCD Psychiatry Services PLLC Psychiatry CurrentSince Jun 30, 2023 Accepting new patients
Neurology Associates of Stony Brook, University Faculty Practice Corpo Past Accepting new patients

Locations

4435 E Chandler Blvd
Ste 200
Phoenix, AZ 85048
Phone (480) 930-2322

100 Pine St
Ste 1250
San Francisco, CA 94111
Phone (415) 390-5445

109 W 27th St
#55
New York, NY 10001

109 W 27th St
Rm 5S
New York, NY 10001
Phone (332) 230-4572

13555 SE 36th St
Ste 100
Bellevue, WA 98006

400 Union Ave SE
Ste 200
Olympia, WA 98501
Phone (202) 375-4508

Interoperability endpoints

  • Direct secure messaging: adeeb.yacoub@direct.stonybrookmedicine.edu

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747526400000",
    "number": "1013938828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 W 27TH ST RM 5S",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100016208",
            "telephone_number": "833-351-8255",
            "fax_number": "888-815-3583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 W 27TH ST STE 5S",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100016208",
            "telephone_number": "833-351-8255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Union Ave SE Ste 200",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985012060",
            "country_code": "US",
            "telephone_number": "833-351-8255",
            "fax_number": "888-815-3583",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Pine St Ste 1250",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941115235",
            "country_code": "US",
            "telephone_number": "833-351-8255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4435 E Chandler Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850487651",
            "country_code": "US",
            "telephone_number": "833-351-8255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YACOUB",
        "first_name": "ADEEB",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2025-05-18",
        "certification_date": "2025-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "178589",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "220585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02171864",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7711407",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.