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THEODORE R DACOSTA DO
NPI 1114420155
Internal Medicine - Gastroenterology in West Orange, NJ

Active since March 15, 2018PECOS Enrolled
59 MAIN ST STE 1, WEST ORANGE, NJ 07052(973) 674-8866 Get Directions Write a Review

NPPES record last updated: May 30, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Theodore R Dacosta Do NPPES

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

THEODORE R DACOSTA DO (NPI 1114420155) is an individual gastroenterology provider in West Orange, New Jersey, licensed in New Jersey (25MB12193600) and active in the NPI registry since March 2018. He is enrolled in Medicare PECOS and maintains a secondary practice location in West Orange.

NPPES Registry Identity

NPI1114420155
Entity TypeIndividualMale
Primary Taxonomy207RG0100X
Provider Legal NameTHEODORE R DACOSTACredential: DO
Location Address59 MAIN ST STE 1West Orange, NJ 07052-5341
Mailing Address26 Mcchesney CtWest Orange, NJ 07052-1135 · (973) 699-3950
Phone(973) 674-8866
Sole ProprietorNo
Enumeration DateMarch 15, 2018
Last NPPES UpdateMay 30, 2024
NPPES CertifiedMay 30, 2024
✔ NPI 1114420155 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code207RG0100X
License✔ Licensed in NJ · 25MB12193600
Definition
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
59 MAIN ST STE 1, West Orange, NJ 07052
Open in Google Maps ↗

Secondary Practice Location 1

Location 126 McChesney CtWest Orange, NJ 07052-1135 · Phone (973) 699-3950

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Theodore R Dacosta Do 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 Theodore Dacosta reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Dacosta Medical Group LLC
0.3 mi
Gastroenterology
85 S JEFFERSON STREET
Orange, NJ 07050
  • Reassigned Medicare billing, New Jersey enrollment
  • 2 clinicians in this Medicare group
NPI 1346461282 (973) 674-8866

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 07052 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
$144.86 typical visit price
range $63.84 – $190.92
Typical copayment $36.21 (range $15.96 – $47.73)
Most-billed visit code 99204
Established Patient
$111.57 typical visit price
range $20.97 – $155.92
Typical copayment $27.89 (range $5.24 – $38.98)
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.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Theodore Dacosta's NPI number?

The NPI number for Theodore Dacosta is 1114420155. It was assigned to this individual provider in the NPPES registry on March 15, 2018.

Where is Theodore Dacosta located?

Theodore Dacosta practices at 59 Main St Ste 1, West Orange, NJ 07052. The listed phone number is (973) 674-8866.

What is Theodore Dacosta's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Gastroenterology, with taxonomy code 207RG0100X.

Is Theodore Dacosta enrolled in Medicare?

Yes. Theodore Dacosta is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Theodore Dacosta's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Theodore Dacosta reassigns Medicare benefits to Dacosta Medical Group LLC (Orange, NJ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Theodore Dacosta's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Theodore Dacosta was last updated on May 30, 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.