MR. SHANE SAJI JACOB PA
NPI 1609484468
Physician Assistant in Elmhurst, NY

Q: What is Shane Jacob's NPI number?

The NPI number for Shane Jacob is 1609484468. It was assigned to this individual provider in the NPPES registry on July 17, 2020.

Q: What is Shane 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 Shane Jacob was last updated on February 26, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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 July 17, 2020PECOS EnrolledAccepts Medicare Assignment

7901 BROADWAY, ELMHURST, NY 11373(718) 334-2480(718) 334-2478 Get Directions Write a Review

NPPES record last updated: February 26, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 26, 2021, Aug 31, 2020, Jul 17, 2020 (3 updates tracked since 2020).

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About Mr. Shane Saji Jacob Pa NPPES

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

MR. SHANE SAJI JACOB PA (NPI 1609484468) is an individual physician assistant in Elmhurst, New York, licensed in New York (025732) and active in the NPI registry since July 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1609484468

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameMR. SHANE SAJI JACOBCredential: PA

Location Address7901 BROADWAYElmhurst, NY 11373-1329

Mailing Address7901 BroadwayElmhurst, NY 11373-1329 · (718) 334-2480 · Fax (718) 334-2478

Phone(718) 334-2480

Fax(718) 334-2478

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateJuly 17, 2020

Last NPPES UpdateFebruary 26, 20213 updates tracked since enumeration

NPPES CertifiedFebruary 26, 2021

✔ NPI 1609484468 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in NY · 025732

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.

7901 BROADWAY, Elmhurst, NY 11373

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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

Mr. Shane Saji Jacob Pa 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 ID8820404098

PECOS Enrollment IDI20210312001472

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.

Areas of Expertise CMS Part B claims 10

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

334 services281 patients

Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19) 87811

This is a test to detect COVID-19, the virus causing severe respiratory illness. It uses a method called immunoassay, which identifies the virus by its unique proteins. The test is directly observed for accuracy. It helps determine if you're currently infected.

236 services222 patients

Detection test by immunoassay with direct visual observation for influenza virus 87804

This is a test that identifies the influenza virus in your body. It works by using an immunoassay, a method that detects the presence of the virus through an immune response. The results are directly observable, making it a quick and efficient way to diagnose flu.

184 services92 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

107 services105 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

62 services62 patients

Automated urinalysis test 81003

An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.

32 services28 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11373 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

$104.17 typical visit price

range $67.00 – $201.98

Typical copayment $26.04 (range $16.75 – $50.49)

Most-billed visit code 99203

Established Patient

$82.96 typical visit price

range $21.62 – $163.52

Typical copayment $20.74 (range $5.40 – $40.88)

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.

MR. PAUL ADRIAN POWELL P.A

Physician Assistant