Jacob Robert Peacock, MD

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

293819-1 Issued in NY

Practice address

102 Clifton PL Apt 1a
Brooklyn, NY 11238-7218

Phone

(616) 894-1615

NPI assigned

May 21, 2013

Last updated

Jul 19, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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 1

Specialty

Physical Medicine and Rehabilitation

Education

Michigan State University College of Human Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ko Medical Rehabilitation, PLLCGroup PAC ID 8224470463, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

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

• Ko Medical Rehabilitation, PLLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Plainview, NY
  • NPI 1679324438
  Medicare reassignment Care Compare group NPD
• KM Rehabilitation Physicians PLLC

  • Physical Medicine & Rehabilitation Physician
  • Rockville Centre, NY
  • NPI 1639032576
  Medicare reassignment NPD
• Kumar Medical Pain Management PC

  • Physical Medicine & Rehabilitation Physician
  • Plainview, NY
  • NPI 1417575911
  Medicare reassignment NPD
• Lifeline Tests Incorporated

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Freeport, NY
  • NPI 1306645577
  NPD Authorized official
• South Nassau Orthopedic Surgery and Sports Medicine, P.C.

  • Orthopaedic Surgery Physician
  • Valley Stream, NY
  • NPI 1154332344
  NPD (past)

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

{
    "created_epoch": "1369094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1083050785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 CLIFTON PL APT 1A",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112387218",
            "telephone_number": "616-894-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 CLIFTON PL APT 1A",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112387218",
            "telephone_number": "616-894-1615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1414 Newkirk Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112266599",
            "country_code": "US",
            "telephone_number": "718-759-6100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "40 Park Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100163467",
            "country_code": "US",
            "telephone_number": "718-759-6100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "142 Joralemon St",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112014747",
            "country_code": "US",
            "telephone_number": "718-759-6100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "JACOB",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-21",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NY",
            "license": "293819-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peaceful Psychotherapy Mental Health Counseling PLLC
• Peaceful Swan Integrative Psychiatry NP in Psychiatry PLLC
• Ashley Peaceman, PT,DPT
• Peach and Vibes Transportation Corp
• Peach Tikvah/ Door of Hope
• Jennifer Nicole Peacock, M.D.
• Peter Peacock, MD
• Peak Communications Inc
• Peak Physical Therapy of Brooklyn, PLLC
• Feafea Moore Peal, FNP-C

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.