Jake T Broccolo, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT03093 Issued in RI

Practice address

1401 Douglas Ave
North Providence, RI 02904-4058

Phone

(401) 726-7100

NPI assigned

Aug 10, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in RI, MA2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Silver Fern Practice LLCGroup PAC ID 1658266515, 297 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

80.9 of 100Reported as group

Quality

79.21

Improvement activities

40

Cost

74.46

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Silver Fern Practice, LLC

  • Physical Therapist
  • Providence, RI
  • NPI 1851472914

  MA

  Medicare reassignment Care Compare group NPD
• Elite Physical Therapy, LLC

  • Physical Therapist
  • Warwick, RI
  • NPI 1225123565
  Medicare reassignment NPD
• Silver Fern Practice, LLC

  • Physical Therapist
  • Smithfield, RI
  • NPI 1013583426
  NPD

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

{
    "created_epoch": "1533859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769731200000",
    "number": "1144709114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 RICHMOND SQ",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029065117",
            "telephone_number": "401-433-4172",
            "fax_number": "401-433-0612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 DOUGLAS AVE",
            "city": "NORTH PROVIDENCE",
            "state": "RI",
            "postal_code": "029044058",
            "telephone_number": "401-726-7100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1295 Fall River Ave",
            "address_purpose": "LOCATION",
            "city": "Seekonk",
            "state": "MA",
            "postal_code": "027715931",
            "country_code": "US",
            "telephone_number": "508-231-5944",
            "fax_number": "401-433-0612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCCOLO",
        "first_name": "JAKE",
        "middle_name": "T",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-10",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "PTL88684",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "RI",
            "license": "PT03093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gloria Bongiorno, FNP-C
• Willie Borkai
• Jeffrey Borozny
• Warren W Bovie, MD
• Remuel Belen Briones, M.D.
• Kathleen Brown, DPT
• Melissa A. Brunelle, P.T.
• Elizabeth MJ Brunelli
• Jennifer Bruni, NP
• Erika Bruno, D.C

• Physical Therapist in North Providence, RI
• Providers in North Providence, RI by specialty
• Physical Therapist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.