Active NPI
Jake Roldan Restivo
- Physician Assistant
- Washington, DC
National Provider Identifier
1477351690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 2300 I St NW
Washington, DC 20052-0011 - Phone
- (202) 994-2987
- NPI assigned
- Mar 4, 2025
- Last updated
- Aug 19, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
2300 I St NW
Washington, DC 20052-0011
Mailing address
1561 Division St
West Charlton, NY 12010-6810
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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260129003413 | NY | Order and Referring Only - Physician Assistant | 6204314354 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034231 | NY | MD | Physical Therapist |
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
Interoperability endpoints
- jrestivo6440098@nychhc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1741046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755561600000",
"number": "1477351690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1561 DIVISION ST",
"city": "WEST CHARLTON",
"state": "NY",
"postal_code": "120106810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 I ST NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200520011",
"telephone_number": "202-994-2987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RESTIVO",
"first_name": "JAKE",
"middle_name": "ROLDAN",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2025-03-04",
"last_updated": "2025-08-19",
"certification_date": "2025-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.