NPIMap

Individual provider Active NPI

Jacob A Dicesare, DO

  • Sports Medicine (Family Medicine) Physician
  • Greensburg, PA
National Provider Identifier
1184862427
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
OS014434 Issued in PA
Practice address
438 Pellis Rd
Greensburg, PA 15601-7900
Phone
(724) 261-4080
Fax
(724) 261-4081
NPI assigned
Jan 24, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X OS014434 PA Primary

Addresses

Primary practice location

438 Pellis Rd
Greensburg, PA 15601-7900

Mailing address

PO Box 7
Bovard, PA 15619-0007
Phone (724) 261-4080

Other practice location 1

8775 Norwin Ave Ste 107
North Huntingdon, PA 15642-7705
Phone (724) 261-4080

Other practice location 2

599 N Church St Ste 200
Mount Pleasant, PA 15666-1004
Phone (724) 261-4080

Other identifiers 1

IdentifierTypeStateIssuer
102533207 0001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100104000058 PA Practitioner - Sports MedicinePractitioner - Family PracticePractitioner - Emergency Medicine 8325189020 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

605 Fairwinds CT
Greensburg, PA 15601-7723

700 Pellis Rd
Lowr 1
Greensburg, PA 15601-4488
Phone (724) 261-4080

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Dicesare Orthopedic Medicine LLC Sports Medicine CurrentSince Apr 7, 2020 Accepting new patients
Concordia Hospice of Washington Sports Medicine CurrentSince Jul 1, 2020 Accepting new patients
Upmc Washington Sports Medicine CurrentSince Jul 1, 2020 Accepting new patients
Dicesare Orthopedic Medicine LLC Sports Medicine CurrentSince Jun 1, 2020 Accepting new patients
Medexpress Urgent Care, PC - Monaca Past Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Upmc St. Margaret Past Accepting new patients

Locations

700 Pellis Rd
Lowr 1
Greensburg, PA 15601
Phone (724) 261-4080

438 Pellis Rd
Greensburg, PA 15601
Phone (412) 782-1500

1 Aesthetic Way
Greensburg, PA 15601
Phone (412) 275-0227

8775 Norwin Ave
Ste 107
North Huntingdon, PA 15642
Phone (724) 261-4080

95 Leonard Ave
Washington, PA 15301
Phone (724) 223-3100

95 Leonard Ave
Bldg 2
Washington, PA 15301
Phone (724) 223-3100

Interoperability endpoints

  • Direct secure messaging: jacob@dom.medentdirect.com

Organizations & group practices 7

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.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1232755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1184862427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7",
            "city": "BOVARD",
            "state": "PA",
            "postal_code": "156190007",
            "telephone_number": "724-261-4080",
            "fax_number": "724-261-4081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 PELLIS RD",
            "city": "GREENSBURG",
            "state": "PA",
            "postal_code": "156017900",
            "telephone_number": "724-261-4080",
            "fax_number": "724-261-4081"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8775 Norwin Ave Ste 107",
            "address_purpose": "LOCATION",
            "city": "North Huntingdon",
            "state": "PA",
            "postal_code": "156427705",
            "country_code": "US",
            "telephone_number": "724-261-4080",
            "fax_number": "724-261-4081",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "599 N Church St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "PA",
            "postal_code": "156661004",
            "country_code": "US",
            "telephone_number": "724-261-4080",
            "fax_number": "724-261-4081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICESARE",
        "first_name": "JACOB",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-24",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "PA",
            "license": "OS014434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102533207 0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensburg, PA

Sources for this page

Verify at the official NPI Registry.