Active NPI
Jacob Convissar, DO
- Student in an Organized Health Care Education/Training Program
- Pittsburgh, PA
National Provider Identifier
1154959971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 4401 Penn Ave
Upmc Children'S Hospital of Pittsburgh
Pittsburgh, PA 15224-1334 - Phone
- (412) 692-5235
- NPI assigned
- Mar 28, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
4401 Penn Ave
Upmc Children'S Hospital of Pittsburgh
Pittsburgh, PA 15224-1334
Mailing address
3600 Forbes Ave
Forbes Tower- Plaza Level Suite 140
Pittsburgh, PA 15213-3410
Phone (724) 281-3297
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Interoperability endpoints
- jconvissar1119494@direct.hopkinsmedicine.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769644800000",
"number": "1154959971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 FORBES AVE",
"address_2": "FORBES TOWER- PLAZA LEVEL SUITE 140",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "152133410",
"telephone_number": "724-281-3297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4401 PENN AVE",
"address_2": "UPMC CHILDREN'S HOSPITAL OF PITTSBURGH",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "152241334",
"telephone_number": "412-692-5235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONVISSAR",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-28",
"last_updated": "2026-01-29",
"certification_date": "2026-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Pittsburgh, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2026; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.