Jacob White, MD
Individual provider Active NPI Vascular & Interventional Radiology Physician · New York, NY
NPI 1386969210 · NPPES record last updated Nov 29, 2018
Key facts
- NPI
- 1386969210
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Vascular & Interventional Radiology Physician 2085R0204X
- License
- 264822 (NY)
- Practice address
- 1264 Saint Nicholas Ave
New York, NY 10033-7263 - Phone
- (347) 532-1845
- Fax
- (718) 301-1099
- NPI assigned
- Apr 4, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 41
Medicare Care Compare profile
- Specialty
- Interventional Radiology
- Education
- Georgetown University School of Medicine, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pelham Pkwy Professional Medical Services of New York LLC
Pelham Pkwy Medical of New York LLC
Valley Stream Professional Medical Services, LLC
USA Vein Clinics of New Jersey LLC
USA Vascular Center of New Jersey LLC
Practice addresses (Care Compare)
2157 White Plains Rd
Suite a
Bronx, NY 10462-1405
Phone (347) 532-1845
260 W Sunrise Hwy
Suite 102a
Valley Stream, NY 11581-1016
Phone (718) 393-5332
272 Main St
Suite B
Orange, NJ 07050-3605
Phone (862) 930-1267
30 W Century Rd
Suite 215
Paramus, NJ 07652-1440
Phone (551) 261-4372
4201 Bergenline Ave
Suite 1a
Union City, NJ 07087-4923
Phone (847) 593-8460
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Varicose vein removal | 198 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in NY, IL, NJ, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171113001088 | NY | Practitioner - Interventional Radiology | 9436457579 | Reassigns benefits to 23 organizations |
| I20180222000002 | IL | Practitioner - Diagnostic Radiology | 9436457579 | Reassigns benefits to 6 organizations |
| I20190530002694 | NJ | Practitioner - Interventional Radiology | 9436457579 | Reassigns benefits to 2 organizations |
| I20231204002751 | TX | Practitioner - Interventional Radiology | 9436457579 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 264822 | NY | MD | Vascular & Interventional Radiology Physician |
Practice roles (28 of 32)
Locations (25 of 87)
9010 Strada Stell Ct
Ste 103
Naples, FL 34109
Phone (800) 669-7744
3927 W Belmont Ave
Ste 103
Chicago, IL 60618
6415 W Archer Ave
Chicago, IL 60638
Phone (773) 788-1702
7230 W North Ave
Ste 108
Elmwood Park, IL 60707
Phone (847) 593-8616
550 N Lake St
Ste 1
Mundelein, IL 60060
550 N Lake St
Mundelein, IL 60060
Phone (847) 548-9777
304 Wainwright Dr
Ste 120
Northbrook, IL 60062
4141 Dundee Rd
Northbrook, IL 60062
Phone (224) 292-5411
304 Wainwright Dr
Northbrook, IL 60062
Phone (224) 318-0118
4139 Dundee Rd
Northbrook, IL 60062
272 Main St
#A
Orange, NJ 07050
Phone (862) 212-1084
30 W Century Rd
Ste 215A
Paramus, NJ 07652
50 E State St
Ste 100A
Trenton, NJ 08608
Phone (609) 900-3134
4201 Bergenline Ave
Ste 1A
Union City, NJ 07087
3033 Steinway St
Ste C
Astoria, NY 11103
Phone (347) 773-2684
3033 Steinway St
Astoria, NY 11103
Phone (718) 709-5329
4025 Hempstead Tpke
Ste A
Bethpage, NY 11714
Phone (646) 798-8502
480 Hicksville Rd
Bethpage, NY 11714
Phone (516) 796-2222
3485 Jerome Ave
#A
Bronx, NY 10467
Phone (347) 547-3099
947 Southern Blvd
Ste A
Bronx, NY 10459
Phone (718) 513-5855
1949 Westchester Ave
Ste A
Bronx, NY 10462
Phone (929) 254-3405
384 E 149th St
Ste 201A
Bronx, NY 10455
Phone (844) 723-7240
2157 White Plains Rd
Ste B
Bronx, NY 10462
1949 Westchester Ave
Ste B
Bronx, NY 10462
Phone (929) 248-4824
2157 White Plains Rd
Ste A
Bronx, NY 10462
Phone (347) 532-1845
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | 264822 | NY | Yes |
Addresses
Primary practice location
1264 Saint Nicholas Ave
New York, NY 10033-7263
Mailing address
PO Box 32
Northbrook, IL 60065-0032
Phone (224) 318-0118
Other practice location 1
300 Community Dr
Manhasset, NY 11030-3816
Phone (516) 562-0100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04887023 | Medicaid | NY |
Other providers in New York, NY
- Handel White
- Harrison Nicholas White
- Harvey Lee White
- Hayley White
- Holly Lynn White
- Jason James White
- Jay Brandon Wilson White
- Jess White
- Jessica Mary-Kathleen Ayanna White
- John White
All providers in New York, NY · Vascular & Interventional Radiology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.