MISS STACY JACOB
NPI 1104333178
Physician Assistant in Staten Island, NY

Q: What is Stacy Jacob's NPI number?

The NPI number for Stacy Jacob is 1104333178. It was assigned to this individual provider in the NPPES registry on December 29, 2017.

Q: What is Stacy Jacob's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Stacy Jacob was last updated on February 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 29, 2017PECOS EnrolledAccepts Medicare Assignment

475 SEAVIEW AVE, STATEN ISLAND, NY 10305(718) 266-9000 Get Directions Write a Review

NPPES record last updated: February 2, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 2, 2026, Jan 21, 2023, May 16, 2022 and 1 more (4 updates tracked since 2017).

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About Miss Stacy Jacob NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISS STACY JACOB (NPI 1104333178) is an individual physician assistant in Staten Island, New York, licensed in New Jersey (25MP00995000) and active in the NPI registry since December 2017. She is enrolled in Medicare PECOS, is affiliated with Staten Island University Hospital, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1104333178

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMISS STACY JACOB

Location Address475 SEAVIEW AVEStaten Island, NY 10305-3436

Mailing Address475 Seaview AveStaten Island, NY 10305-3436 · (718) 226-9000

Phone(718) 266-9000

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateDecember 29, 2017

Last NPPES UpdateFebruary 2, 20264 updates tracked since enumeration

NPPES CertifiedFebruary 2, 2026

✔ NPI 1104333178 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in NJ · 25MP00995000

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Also ListedLicensed Practical NurseTaxonomy 164W00000X · License 329541-1 (NY)

475 SEAVIEW AVE, Staten Island, NY 10305

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Miss Stacy Jacob is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4587038021

PECOS Enrollment IDI20230323000913

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Staten Island University Hospital

Acute Care Hospitals · Staten Island, NY

1/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number330160

Location475 Seaview AvenueStaten Island, NY 10305 · Richmond County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10305 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$105.06 typical visit price

range $67.40 – $203.53

Typical copayment $26.26 (range $16.85 – $50.88)

Most-billed visit code 99203

Established Patient

$83.44 typical visit price

range $21.66 – $164.45

Typical copayment $20.86 (range $5.41 – $41.11)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. DAWN MARIE COTTONE RPA-C

Physician Assistant (Surgical)