Samuel Sunny Jacob, D.O.

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

25MB11490200 Issued in NJ

Practice address

1200 East Ridgewood Avenue
East Wing, Suite 306,
Ridgewood, NJ 07450

Phone

(201) 612-4857

NPI assigned

Mar 28, 2017

Sex

Male

Sole proprietor

No

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 NJ

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

National College of Chiropractic, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley Physician Services PCGroup PAC ID 3577857333, 593 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Valley Home Care Inc. Home health agency, Paramus, NJ, CCN 317008
• Valley Hospital Hospital, Paramus, NJ, CCN 310012
• St Joseph's University Medical Center Inc Hospital, Paterson, NJ, CCN 310019
• Kessler Rehab Center Inpatient rehabilitation facility, West Orange, NJ, CCN 313025

Merit-based Incentive Payment System (MIPS)

Final score

95.05 of 100Reported as apm

Quality

85.71

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samuel.jacob.1@5622.direct.athenahealth.com

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.

• Valley Physician Services PC

  • Internal Medicine Physician
  • Paramus, NJ
  • NPI 1467815928
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Kessler Institute for Rehabilitation Inc

  dba Kessler Rehabilitation Center

  • Rehabilitation Hospital
  • West Orange, NJ
  • NPI 1013919620

  Inpatient rehabilitation facility

  Care Compare affiliation
• St Josephs University Medical Center Inc.

  • General Acute Care Hospital
  • Paterson, NJ
  • NPI 1669462420
  Care Compare affiliation
• The Valley Hospital Inc.

  • General Acute Care Hospital
  • Paramus, NJ
  • NPI 1013912633
  Care Compare affiliation
• Valley Home Care, Inc

  • Home Health Agency
  • Paramus, NJ
  • NPI 1174588925
  Care Compare affiliation

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

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1134651391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 MARTINO WAY",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "109702649",
            "telephone_number": "914-318-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 EAST RIDGEWOOD AVENUE",
            "address_2": "EAST WING, SUITE 306,",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "07450",
            "telephone_number": "201-612-4857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "SAMUEL",
        "middle_name": "SUNNY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-28",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NJ",
            "license": "25MB11490200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mohammed Waqas Iqbal, DDS
• Mahros K Isaac, P.T.
• Roni Isaacson, LCSW
• Reem Jaber-Iqbal, DO
• Betsy Jacob
• Warren Craig Jacoby, D.C
• Jada LLC (Levato and Gaudiomonte Opticians)
• James F Battaglia Psychology PC
• Michael Douglas James, PHD
• Michelle James, PA-C

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Ridgewood, NJ
• Providers in Ridgewood, NJ by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.