DR. JACK JACOB D.O.
NPI 1649659590
Pathology - Anatomic Pathology & Clinical Pathology in Bridgeport, CT
About Dr. Jack Jacob D.o. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. JACK JACOB D.O. (NPI 1649659590) is an individual anatomic pathology & clinical pathology provider in Bridgeport, Connecticut, licensed in Connecticut (68885) and active in the NPI registry since May 2015. He is enrolled in Medicare PECOS and is a graduate of New York College Of Osteo Medicine Of New York Institute Of Technology (2015).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Jack Jacob D.o. 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.
Medicare Billing Reassignments
2Medicare enrollment records show Jack Jacob reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Bridgeport, CT 06606
- Reassigned Medicare billing, Connecticut enrollment
- 5 clinicians in this Medicare group
Hartford, CT 06106
- Reassigned Medicare billing, Connecticut enrollment
- 417 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 25
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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 06606 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
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.
BRIDGEPORT, CT 06606
BRIDGEPORT, CT 06606
BRIDGEPORT, CT 06606
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 Jack Jacob's NPI number?
The NPI number for Jack Jacob is 1649659590. It was assigned to this individual provider in the NPPES registry on May 26, 2015.
Where is Jack Jacob located?
Jack Jacob practices at 2800 Main St, Bridgeport, CT 06606. The listed phone number is (862) 812-7831.
What is Jack Jacob's specialty?
The primary specialty registered for this NPI is Pathology, specializing in Anatomic Pathology & Clinical Pathology, with taxonomy code 207ZP0102X.
Is Jack Jacob enrolled in Medicare?
Yes. Jack Jacob is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Jack Jacob's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jack Jacob reassigns Medicare benefits to 2 organizations: Fairfield County Pathology Consultants, LLC (Bridgeport, CT) and Connecticut Gi PLLC (Hartford, CT). Each 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 Jack 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 Jack Jacob was last updated on September 22, 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.
# Dr. Jack Jacob, D.O. · NPI 1649659590
Anatomic Pathology & Clinical Pathology physician in Bridgeport, Connecticut. Individual provider, active in the CMS NPPES registry since May 26, 2015.
## Identity
- **NPI:** 1649659590 (Entity type: Individual)
- **Enumerated:** May 26, 2015
- **Primary specialty:** Pathology - Anatomic Pathology & Clinical Pathology · taxonomy 207ZP0102X
- **State license:** 68885 (Connecticut)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 2800 MAIN ST, Bridgeport, CT 06606-4201
- **Phone:** (862) 812-7831
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Fairfield County Pathology Consultants, LLC (NPI 1518064757, Bridgeport, CT); Connecticut Gi PLLC (NPI 1023124625, Hartford, CT) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** New York College Of Osteo Medicine Of New York Institute Of Technology, class of 2015
## Record status
- **NPPES last updated:** September 22, 2021
---
Source: [NPI Profile](https://npiprofile.com/npi/1649659590) · Data from the CMS NPPES public registry.