Jacob Putkowski, PA-C
Individual provider Active NPI Physician Assistant · Plantation, FL
NPI 1093054652 · NPPES record last updated Jan 28, 2022
Key facts
- NPI
- 1093054652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA9107020 (FL)
- Practice address
- 1368 N University Dr
Plantation, FL 33322-4734 - Phone
- (954) 577-0001
- NPI assigned
- Feb 1, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- North Shore Lij Urgent Care PC
Practice addresses (Care Compare)
1011 High Ridge Rd
Suite 101
Stamford, CT 06905-1604
Phone (475) 477-2330
186 Route 52
Carmel, NY 10512-1200
Phone (845) 936-0002
1953 Black Rock Tpke
Fairfield, CT 06825-3506
Phone (475) 273-8590
205 Main St
Suite 7
Norwalk, CT 06851-3530
Phone (475) 257-6057
3 Sugar Hollow Rd
Danbury, CT 06810-7401
Phone (475) 348-3782
377 S Oyster Bay Rd
Plainview, NY 11803-3323
Phone (516) 537-9061
Hospital & facility affiliations
- Danbury Hospital
- Putnam Hospital Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in FL, CT, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150226001332 | FL | Practitioner - Physician Assistant | 6103142765 | Reassigns benefits to 3 organizations |
| I20210715001780 | CT | Practitioner - Physician Assistant | 6103142765 | Reassigns benefits to 2 organizations |
| I20220202001555 | NY | Practitioner - Physician Assistant | 6103142765 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 027832 | NY | MD | Clinical Neuropsychologist |
Interoperability endpoints
- jacob.putkowski@ghuc.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9107020 | FL | Yes |
| Physician Assistant | 363A00000X | 027832 | NY |
Addresses
Primary practice location
1368 N University Dr
Plantation, FL 33322-4734
Mailing address
5229 N Dixie Hwy
Apt 29C2
Oakland Park, FL 33334-4028
Phone (203) 300-9224
Other providers in Plantation, FL
- Sat P Punyani
- David Florin Pupaza
- Pupo Dental, Inc
- Pur Aesthetics
- Subhash Ramchandra Puranik
- Theresa Pyle
- Nancy Pyram-Bernard
- Balawal Qaiser
- Quality Diagnostic & Medical Center Inc.
- Quality Health Care of Florida.LLC
All providers in Plantation, FL · Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.