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DR. BENNA THAYIL JACOB DO
NPI 1477247948
Student in an Organized Health Care Education/Training Program in Mineola, NY

Active since June 06, 2023PECOS Enrolled
222 STATION PLZ N STE 509, MINEOLA, NY 11501(516) 663-2381 Get Directions Write a Review

NPPES record last updated: June 6, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Benna Thayil Jacob Do NPPES

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

DR. BENNA THAYIL JACOB DO (NPI 1477247948) is an individual student in an organized health care education/training program in Mineola, New York and active in the NPI registry since June 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1477247948
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameDR. BENNA THAYIL JACOBCredential: DO
Location Address222 STATION PLZ N STE 509Mineola, NY 11501-3893
Mailing Address130 Radcliffe RdPlainview, NY 11803-1218 · (516) 236-4236
Phone(516) 663-2381
Sole ProprietorYes
Medical School CMSOtherGraduated 2023
Enumeration DateJune 6, 2023
NPPES CertifiedJune 6, 2023
✔ NPI 1477247948 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
222 STATION PLZ N STE 509, Mineola, NY 11501
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Benna Thayil Jacob Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID648737403
PECOS Enrollment IDI20260811004971
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 Benna Jacob reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

New York University
1,045 mi
Cardiovascular Disease
3301 QUANTUM BLVD
Boynton Beach, FL 33426
  • Reassigned Medicare billing, New York enrollment
  • 7,712 clinicians in this Medicare group
NPI 1285826438 (877) 648-2964

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

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.

DR. ERIK LAWRENCE MD
Radiology (Diagnostic Radiology)
222 STATION PLZ N STE 509
MINEOLA, NY 11501
Nassau County (516) 663-2381
YAATHIKA CHALLAPALLI MD
Student in an Organized Health Care Education/Training Program
222 STATION PLZ N STE 509
MINEOLA, NY 11501
Nassau County (516) 663-2381
BYEONGHO JUNG MD
Student in an Organized Health Care Education/Training Program
222 STATION PLZ N STE 509
MINEOLA, NY 11501
Nassau County (516) 663-2381
MATTHEW SEIBERT MD
Student in an Organized Health Care Education/Training Program
222 STATION PLZ N STE 509
MINEOLA, NY 11501
Nassau County (516) 663-2381
DARAN SCHILLER MD
Student in an Organized Health Care Education/Training Program
222 STATION PLZ N STE 509
MINEOLA, NY 11501
Nassau County (516) 663-2381
BILLY DING
Student in an Organized Health Care Education/Training Program
222 STATION PLZ N STE 509
MINEOLA, NY 11501
Nassau County (516) 663-2381
ALEXANDER GREENSTONE
Student in an Organized Health Care Education/Training Program
222 STATION PLZ N STE 509
MINEOLA, NY 11501
Nassau County (646) 929-7870
TREVOR JAMES MCHUGH MD
Student in an Organized Health Care Education/Training Program
222 STATION PLZ N STE 509
MINEOLA, NY 11501
Nassau County (516) 663-1500

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 Benna Jacob's NPI number?

The NPI number for Benna Jacob is 1477247948. It was assigned to this individual provider in the NPPES registry on June 6, 2023.

Where is Benna Jacob located?

Benna Jacob practices at 222 Station Plz N Ste 509, Mineola, NY 11501. The listed phone number is (516) 663-2381.

What is Benna Jacob's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Benna Jacob enrolled in Medicare?

Yes. Benna Jacob is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Benna Jacob's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Benna Jacob reassigns Medicare benefits to New York University (Boynton Beach, FL). 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 Benna Jacob'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 Benna Jacob was last updated on June 6, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.