JACOB DANIEL CANAVAN MD
NPI 1104402908
Emergency Medicine in Bronx, NY

Q: What is Jacob Canavan's NPI number?

The NPI number for Jacob Canavan is 1104402908. It was assigned to this individual provider in the NPPES registry on March 22, 2021.

Q: What is Jacob Canavan's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Q: When was this NPI record last updated?

The NPPES record for Jacob Canavan was last updated on September 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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 March 22, 2021PECOS Enrolled

1650 GRAND CONCOURSE, BRONX, NY 10457(718) 992-7669 Get Directions Write a Review

NPPES record last updated: September 3, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 3, 2024, Mar 22, 2021 (2 updates tracked since 2021).

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About Jacob Daniel Canavan Md NPPES

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

JACOB DANIEL CANAVAN MD (NPI 1104402908) is an individual emergency medicine provider in Bronx, New York, licensed in New York (327964) and active in the NPI registry since March 2021. He is enrolled in Medicare PECOS and maintains a secondary practice location in New York.

NPPES Registry Identity

NPI1104402908

Entity TypeIndividualMale

Primary Taxonomy207P00000X

Provider Legal NameJACOB DANIEL CANAVANCredential: MD

Location Address1650 GRAND CONCOURSEBronx, NY 10457-7679

Mailing Address1650 Grand ConcourseBronx, NY 10457-7679 · (718) 992-7669

Phone(718) 992-7669

Sole ProprietorNo

Enumeration DateMarch 22, 2021

Last NPPES UpdateSeptember 3, 20242 updates tracked since enumeration

NPPES CertifiedSeptember 3, 2024

✔ NPI 1104402908 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207P00000X

License✔ Licensed in NY · 327964

Definition

An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.

1650 GRAND CONCOURSE, Bronx, NY 10457

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Secondary Practice Location 1

Location 1250 W 57th StNew York, NY 10107-0001 · Phone (212) 523-8158

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacob Daniel Canavan Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Jacob Canavan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Bronxcare Health System

Same address

Internal Medicine

1650 GRAND CONCOURSE
Bronx, NY 10457

Reassigned Medicare billing, New York enrollment
795 clinicians in this Medicare group

NPI 1245390855 (718) 901-8600

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10457 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

$117.62 typical visit price

range $21.66 – $164.45

Typical copayment $29.40 (range $5.41 – $41.11)

Most-billed visit code 99214

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.

CASSIE LAUREN GREEN M.S., CCC-SLP

Speech-Language Pathologist