Jack Jacob, D.O.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

68885 Issued in CT

Practice address

2800 Main St
Bridgeport, CT 06606-4201

Phone

(862) 812-7831

NPI assigned

May 26, 2015

Last updated

Sep 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

Pathology

Education

New York College of Osteo Medicine of New York Institute of Technology, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairfield County Pathology Consultants, LLCGroup PAC ID 7113969833, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Vincent's Medical Center Hospital, Bridgeport, CT, CCN 070028
• Hartford Hospital Hospital, Hartford, CT, CCN 070025
• Griffin Hospital Hospital, Derby, CT, CCN 070031
• Bridgeport Hospital Hospital, Bridgeport, CT, CCN 070010

Merit-based Incentive Payment System (MIPS)

Final score

58.24 of 100Reported as individual

Quality

78.69

Improvement activities

0

Cost

74.94

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fairfield County Pathology Consultants, LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Bridgeport, CT
  • NPI 1518064757
  Medicare reassignment Care Compare group NPD
• Connecticut Gi PLLC

  • Gastroenterology Physician
  • Hartford, CT
  • NPI 1023124625

  Anatomic Pathology & Clinical Pathology

  Medicare reassignment NPD

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

• Bridgeport Hospital

  • General Acute Care Hospital
  • Bridgeport, CT
  • NPI 1649260845
  Care Compare affiliation
• Bridgeport Hospital

  • General Acute Care Hospital
  • Bridgeport, CT
  • NPI 1992910152
  Care Compare affiliation
• Hartford Hospital

  • General Acute Care Hospital
  • Hartford, CT
  • NPI 1770696643
  Care Compare affiliation
• Hartford Hospital

  • General Acute Care Hospital
  • Hartford, CT
  • NPI 1902834880
  Care Compare affiliation
• SVMC Holdings, Inc

  • General Acute Care Hospital
  • Bridgeport, CT
  • NPI 1942224696
  Care Compare affiliation
• The Griffin Hospital

  • General Acute Care Hospital
  • Derby, CT
  • NPI 1184639973
  Care Compare affiliation

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

{
    "created_epoch": "1432598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1649659590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064201",
            "telephone_number": "862-812-7831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064201",
            "telephone_number": "862-812-7831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-26",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CT",
            "license": "68885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juliet Alexandra Jackson, MD
• Marcus Kirk Jackson, LCSW
• Natacha Jackson
• Samyiah Destiny Jackson
• Tatiana Y Jackson
• Jean K Jacob, PHARM.D.
• Juliet Jacob
• Cheryl Jacobs
• Kathryn Lohotsky Jaffer, CRNA
• Danielle Marie Jagoe

• Anatomic Pathology & Clinical Pathology Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Anatomic Pathology & Clinical Pathology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; 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.