NPIMap

Individual provider Active NPI

Jacob Charles Kurtz, PA-C

  • Physician Assistant
  • Syracuse, NY
National Provider Identifier
1265974265
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
020336 Issued in NY
Practice address
5719 Widewaters Pkwy
Syracuse, NY 13214-6508
Phone
(315) 251-3100
NPI assigned
Nov 8, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 020336 NY Primary

Addresses

Primary practice location

5719 Widewaters Pkwy
Syracuse, NY 13214-6508

Mailing address

5719 Widewaters Pkwy
Syracuse, NY 13214-1877
Phone (315) 251-3105

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
I20170208000124 NY Practitioner - Physician Assistant 4688957194 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopaedic and Neurosurgery Specialists, PLLCGroup PAC ID 5294628947, 255 clinicians

Practice addresses (Care Compare)

520 E 70TH St
New York, NY 10021-9800
Phone (646) 797-8471

535 E 70TH St
New York, NY 10021-4823
Phone (646) 797-8471

600 Northern Blvd
Great Neck, NY 11021-5200
Phone (516) 627-8717

Hospital & facility affiliations

  • Hospital for Special Surgery Hospital, New York, NY, CCN 330270

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Sep 1, 2017 Accepting new patients
Orthopaedic & Neurosurgery Specialists, PLLC Physician Assistant CurrentSince Nov 19, 2025 Accepting new patients
New York University CurrentSince Sep 1, 2017 Accepting new patients
Ny Society for the Relief of Ruptured & Crippled Maintaining CurrentSince Sep 9, 2024 Accepting new patients
Orthopaedic & Neurosurgery Specialists, PLLC CurrentSince Nov 19, 2025 Accepting new patients

Locations

600 Northern Blvd
Ste 300
Great Neck, NY 11021
Phone (516) 627-8717

500 Mamaroneck Ave
Harrison, NY 10528
Phone (203) 869-1145

520 E 70th St
New York, NY 10021
Phone (212) 746-0838

535 E 70th St
New York, NY 10021

Interoperability endpoints

  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
  • Direct secure messaging: pea9049@direct.nyp.org
  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/

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 10

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": "1478563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1265974265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5719 WIDEWATERS PKWY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141877",
            "telephone_number": "315-251-3105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5719 WIDEWATERS PKWY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132146508",
            "telephone_number": "315-251-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KURTZ",
        "first_name": "JACOB",
        "middle_name": "CHARLES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-08",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "020336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.