NPIMap

Individual provider Active NPI

Jacob William Raifstanger, PHYSICIAN ASSISTANT

  • Surgical Physician Assistant
  • Rochester, NY
National Provider Identifier
1679989479
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
017837 Issued in NY
Practice address
2655 Ridgeway Ave Ste 460
Rochester, NY 14626-4296
Phone
(585) 581-6790
Fax
(585) 581-6793
NPI assigned
Jul 1, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 017837 NY Primary

Addresses

Primary practice location

2655 Ridgeway Ave Ste 460
Rochester, NY 14626-4296

Mailing address

100 Kings Hwy S
Rochester, NY 14617-5504
Phone (585) 922-1900

Other practice location 1

1425 Portland Ave
Rochester, NY 14621-3001
Phone (585) 922-3458 ext. 1

Other identifiers 1

IdentifierTypeStateIssuer
03957908MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Jacob.Raifstanger@rochesterregional.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, VT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141007002263 NY Practitioner - Physician Assistant 6608096003 Reassigns benefits to 4 organizations
I20240917005015 VT Practitioner - Physician Assistant 6608096003 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Vermont Medical Center IncGroup PAC ID 3779491071, 1,208 clinicians

Practice addresses (Care Compare)

1 S Prospect St
Burlington, VT 05401-3456
Phone (802) 847-0000

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

192 Tilley Dr
Orthopeadic
S Burlington, VT 05403-4440
Phone (802) 847-4690

Hospital & facility affiliations

  • Univ. of Vermont - Fletcher Allen Health Care Hospital, Burlington, VT, CCN 470003
  • Northwestern Medical Center Inc Hospital, Saint Albans, VT, CCN 470024
  • Porter Hospital Inc Hospital, Middlebury, VT, CCN 471307
  • The University of Vermont Health Network - Champl Hospital, Plattsburgh, NY, CCN 330250
  • Central Vermont Medical Center Hospital, Barre, VT, CCN 470001

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
017837NYMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rochester General Hospital CurrentSince Aug 11, 2014 Accepting new patients
Western New York Medical Practice, P.C. CurrentSince Sep 4, 2019 Accepting new patients
Rochester General Hospital CurrentSince Aug 11, 2014 Accepting new patients
University of Vermont Medical Center Inc CurrentSince Aug 5, 2024 Accepting new patients
The Unity Hospital of Rochester CurrentSince Sep 4, 2019 Accepting new patients
Western New York Medical Practice P.C. CurrentSince Sep 4, 2019 Accepting new patients

Locations

2 Coulter Rd
Clifton Springs, NY 14432
Phone (315) 462-1472

2655 Ridgeway Ave
Ste 460
Rochester, NY 14626
Phone (585) 581-6790

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531

Interoperability endpoints

  • Direct secure messaging: jraifstanger587230@direct.uvmhealth.org
  • Direct secure messaging: jacob.raifstanger@rochesterregional.org

Organizations & group practices 9

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 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1679989479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KINGS HWY S",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146175504",
            "telephone_number": "585-922-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 RIDGEWAY AVE STE 460",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146264296",
            "telephone_number": "585-581-6790",
            "fax_number": "585-581-6793"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1425 Portland Ave",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146213001",
            "country_code": "US",
            "telephone_number": "585-922-3458 x1",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAIFSTANGER",
        "first_name": "JACOB",
        "middle_name": "WILLIAM",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-01",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "017837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03957908",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jacob.Raifstanger@rochesterregional.org",
            "affiliation": "N",
            "address_1": "2655 Ridgeway Ave Ste 460",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146264296",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.