Theodore A Dacosta Jr., MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

25MA05600200 Issued in NJ

Practice address

85 S Jefferson Street
Orange, NJ 07050

Phone

(973) 674-8866

Fax

(973) 672-9299

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

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

Specialty

GastroenterologyAlso: Internal Medicine

Education

Rutgers New Jersey Medical School, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Michael'S Medical Center Hospital, Newark, NJ, CCN 310096

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Dacosta Medical Group LLC

  • Gastroenterology Physician
  • Orange, NJ
  • NPI 1346461282
  Medicare reassignment Authorized official
• Central Avenue Professional Services, PC

  • Critical Care Medicine (Internal Medicine) Physician
  • Newark, NJ
  • NPI 1447649694
  Medicare reassignment NPD

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

• Prime Healthcare Services - St Michaels LLC

  • General Acute Care Hospital
  • Newark, NJ
  • NPI 1568825545
  Care Compare affiliation

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1558395673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 S JEFFERSON STREET",
            "city": "ORANGE",
            "state": "NJ",
            "postal_code": "07050",
            "telephone_number": "973-674-8866",
            "fax_number": "973-672-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 S JEFFERSON STREET",
            "city": "ORANGE",
            "state": "NJ",
            "postal_code": "07050",
            "telephone_number": "973-674-8866",
            "fax_number": "973-672-9299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DACOSTA",
        "first_name": "THEODORE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA05600200",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NJ",
            "license": "25MA05600200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6881106",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cross Counter, Inc
• Abriel Brittney Culver
• D & N Corporation
• D & N Corporation
• Dacosta Medical Group LLC
• Deidre Dann, R.N
• Esther David
• Justein Davis
• DCH Consulting Services, LLC
• Brennan L Deckard

• Gastroenterology Physician in Orange, NJ
• Providers in Orange, NJ by specialty
• Gastroenterology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.