Individual provider Active NPI

Michael Jacoby, M.D.

  • Anesthesiology Physician
  • Valhalla, NY
National Provider Identifier
1255652772
Registry record updated Dec 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
279663 Issued in NY
Practice address
100 Woods Rd
Valhalla, NY 22033-3309
Phone
(914) 493-2844
Fax
(703) 563-6256
NPI assigned
Jun 18, 2010
Last updated
Dec 14, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MT197673 PA
Anesthesiology Physician 207L00000X 279663 NY Primary

Addresses

Primary practice location

100 Woods Rd
Valhalla, NY 22033-3309

Mailing address

11781 Lee Jackson Memorial Hwy
Suite 550
Fairfax, VA 22033-3309
Phone (571) 777-5102

Other identifiers 1

IdentifierTypeStateIssuer
04181682MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20151007001577 NY Practitioner - Anesthesiology 5092023200 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Woods Rd
Valhalla, NY 10595-1530
Phone (914) 490-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
279663NYMDAnesthesiology Physician
MT197673PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Westchester Medical Center Advanced Physician Services PC Anesthesiology CurrentSince Apr 1, 2023 Accepting new patients
Westchester Medical Center Advanced Physician Services, PC Anesthesiology Current Accepting new patients

Locations

100 Woods Rd
Valhalla, NY 10595
Phone (914) 490-7000

95 Grasslands Rd
Valhalla, NY 10595
Phone (914) 493-2961

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 2

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 1

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": "1276819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450051200000",
    "number": "1255652772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11781 LEE JACKSON MEMORIAL HWY",
            "address_2": "SUITE 550",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333309",
            "telephone_number": "571-777-5102",
            "fax_number": "703-563-6256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WOODS RD",
            "city": "VALHALLA",
            "state": "NY",
            "postal_code": "220333309",
            "telephone_number": "914-493-2844",
            "fax_number": "703-563-6256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBY",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-18",
        "last_updated": "2015-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT197673",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "279663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04181682",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valhalla, NY

Sources for this page

Verify at the official NPI Registry.