JACOB L REVERCOMB DDS - NPI 1700987674

Q: What is the provider's specialty?

The provider's specialty is Dentist with taxonomy code 1223G0001X and a focus in General Practice.

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About Jacob L Revercomb Dds NPPES

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

JACOB L REVERCOMB DDS (NPI 1700987674) is an individual general practice provider in Manlius, New York, licensed in New York (048833) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1700987674

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameJACOB L REVERCOMBCredential: DDS

Location Address8076 CAZENOVIA RDManlius, NY 13104

Mailing Address8076 Cazenovia RdManlius, NY 13104 · (315) 682-8400 · Fax (315) 682-2602

Phone(315) 682-8400

Fax(315) 682-2602

Sole ProprietorNo

Enumeration DateSeptember 25, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1700987674 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in NY · 048833

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

8076 CAZENOVIA RD, Manlius, NY 13104

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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 (PECOS)

Jacob L Revercomb Dds 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 13104 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

$84.93 typical visit price

range $54.87 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$68.57 typical visit price

range $17.54 – $136.14

Typical copayment $17.14 (range $4.38 – $34.03)

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 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GARY L REVERCOMB DMD

Dentist (General Practice)