NPIMap

Individual provider Active NPI

Joseph John Jacob, MD

  • Diagnostic Radiology Physician
  • Worcester, MA
National Provider Identifier
1912469495
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
1016855 Issued in MA
Practice address
55 Lake Ave N
Worcester, MA 01655-0002
Phone
(508) 856-5749
Fax
(508) 856-1860
NPI assigned
Apr 3, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 1016855 MA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

55 Lake Ave N
Worcester, MA 01655-0002

Mailing address

PO Box 415348
Boston, MA 02241-5348
Phone (800) 225-8885

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240619001233 MA Practitioner - Diagnostic Radiology 7517295348 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
State University of New York Downstate Medical Center, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Hospital & facility affiliations

  • Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163
  • Umass Memorial Healthalliance Hospitals Hospital, Leominster, MA, CCN 220001
  • Umass Memorial Health - Harrington Hospital Hospital, Southbridge, MA, CCN 220019
  • Marlborough Hospital Hospital, Marlborough, MA, CCN 220049
  • Adcare Hospital of Worcester Inc Hospital, Worcester, MA, CCN 220062

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
82.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1016855MAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Group, Inc. CurrentSince Jun 3, 2024 Accepting new patients
Shields Health at Umass Memorial Health - Milford Regional Medical CurrentSince Dec 1, 2025 Accepting new patients
Umass Memorial Radiology Phys Serv Diagnostic Radiology CurrentSince Dec 1, 2024 Accepting new patients
Umass Memorial MRI & Imaging Center, LLC CurrentSince Jul 1, 2024 Accepting new patients
Umass Memorial MRI & Imaging Center, LLC CurrentSince Jul 1, 2024 Accepting new patients
Umass Memorial Medical Group Inc CurrentSince Jun 3, 2024 Accepting new patients
Umass Memorial MRI & Imaging Center, LLC Diagnostic Radiology CurrentSince Jul 1, 2024 Accepting new patients
Umass Memorial Health Alliance MRI Center LLC CurrentSince Jul 1, 2024 Accepting new patients
Umass Memorial MRI & Imaging Center LLC CurrentSince Jul 1, 2024 Accepting new patients
Shields Health at Umass Memorial Health - Milford Regional Medical CurrentSince Dec 1, 2025 Accepting new patients

Locations

14 Prospect St
Milford, MA 01757
Phone (508) 422-2343

340 Thompson Rd
Webster, MA 01570
Phone (508) 943-2600

10 Little Brook Rd
West Wareham, MA 02576

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Organizations & group practices 10

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1912469495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348",
            "telephone_number": "800-225-8885",
            "fax_number": "508-334-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-856-5749",
            "fax_number": "508-856-1860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JOSEPH",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-03",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "1016855",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.