NPIMap

Individual provider Active NPI

Joseph M Jacob, MD

  • Urology Physician
  • Syracuse, NY
National Provider Identifier
1235440090
Registry record updated Apr 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
290265 Issued in NY
Practice address
750 E Adams St
Syracuse, NY 13210-2306
Phone
(315) 464-6106
Fax
(315) 464-6117
NPI assigned
Jun 27, 2010
Last updated
Apr 18, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 11015533A IN
Urology Physician 208800000X 290265 NY Primary

Addresses

Primary practice location

750 E Adams St
Syracuse, NY 13210-2306

Mailing address

251 Salina Meadows Pkwy Ste 100
Syracuse, NY 13212-4516
Phone (315) 464-2000

Other identifiers 1

IdentifierTypeStateIssuer
04813154MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20170906003407 NY Practitioner - Urology 3678713377 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Ohio State University College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Upstate Urology, Inc.Group PAC ID 1254492952, 24 clinicians

Practice addresses (Care Compare)

4900 Broad Rd
Syracuse, NY 13215-2265
Phone (315) 464-6106

550 Harrison St
Suite M
Syracuse, NY 13202-3188
Phone (315) 464-1500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection30
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11015533AINMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upstate Urology, Inc. Urology CurrentSince Aug 7, 2017 Accepting new patients
River Hospital, Inc. CurrentSince Nov 16, 2019 Accepting new patients
MVHS Inc CurrentSince Jan 1, 2024 Accepting new patients
MVHS Inc CurrentSince Jan 1, 2024 Accepting new patients
River Hospital, Inc. CurrentSince Nov 16, 2019 Accepting new patients
Suny Health Science Center at Syracuse Past Accepting new patients

Locations

4 Fuller St
Alexandria Bay, NY 13607
Phone (315) 482-1277

4900 Broad Rd
Ste 2I
Syracuse, NY 13215
Phone (315) 464-6106

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

1676 Sunset Ave
Utica, NY 13502
Phone (315) 624-5567

2215 Genesee St
Rm 105
Utica, NY 13501

Interoperability endpoints

  • Direct secure messaging: jjacob70777@direct.upstate.edu

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1277596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555545600000",
    "number": "1235440090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 SALINA MEADOWS PKWY STE 100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132124516",
            "telephone_number": "315-464-2000",
            "fax_number": "315-464-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-6106",
            "fax_number": "315-464-6117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JOSEPH",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-27",
        "last_updated": "2019-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IN",
            "license": "11015533A",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "290265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04813154",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.