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JACOB CONNELLY
NPI 1790147593
Nurse Practitioner - Family in Los Alamos, NM

Active since March 22, 2016PECOS Enrolled
3917 WEST RD STE A3917, LOS ALAMOS, NM 87544(505) 661-8959(505) 661-8916 Get Directions Write a Review

NPPES record last updated: August 26, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 28, 2020, Feb 11, 2020, Mar 22, 2016 (3 updates tracked since 2016).

About Jacob Connelly NPPES

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

JACOB CONNELLY (NPI 1790147593) is an individual family provider in Los Alamos, New Mexico, licensed in Florida (11005429) and active in the NPI registry since March 2016. He is enrolled in Medicare PECOS, is affiliated with Los Alamos Medical Center, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1790147593
Entity TypeIndividualMale
Primary Taxonomy363LF0000X
Provider Legal NameJACOB CONNELLY
Location Address3917 WEST RD STE A3917Los Alamos, NM 87544-2275
Mailing Address3917 West Rd Ste ALos Alamos, NM 87544-2292 · (505) 661-8959 · Fax (505) 661-8916
Phone(505) 661-8959
Fax(505) 661-8916
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateMarch 22, 2016
Last NPPES UpdateAugust 26, 20253 updates tracked since enumeration
NPPES CertifiedAugust 26, 2025
✔ NPI 1790147593 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in FL · 11005429
Also ListedRegistered NurseTaxonomy 163W00000X · License RN 9409391 (FL)
3917 WEST RD STE A3917, Los Alamos, NM 87544
Open in Google Maps ↗

Secondary Practice Locations 2

Location 18291 Dani Dr Ste 100Fort Myers, FL 33966-8021 · Phone (239) 931-6049
Location 2737 Cape Coral Pkwy ECape Coral, FL 33904-8551 · Phone (239) 542-0512

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 Connelly is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5395164933
PECOS Enrollment IDI20250903000037
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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Los Alamos Medical Center

Acute Care Hospitals · Los Alamos, NM
OwnershipProprietary
CMS Certification Number320033
Location3917 West RoadLos Alamos, NM 87544 · Los Alamos County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 87544 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
$84.79 typical visit price
range $54.26 – $166.80
Typical copayment $21.19 (range $13.56 – $41.70)
Most-billed visit code 99203
Established Patient
$96.38 typical visit price
range $17.00 – $135.35
Typical copayment $24.09 (range $4.25 – $33.83)
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 Jacob Connelly's NPI number?

The NPI number for Jacob Connelly is 1790147593. It was assigned to this individual provider in the NPPES registry on March 22, 2016.

Where is Jacob Connelly located?

Jacob Connelly practices at 3917 West Rd Ste A3917, Los Alamos, NM 87544. The listed phone number is (505) 661-8959.

What is Jacob Connelly's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Jacob Connelly enrolled in Medicare?

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

Is Jacob Connelly affiliated with any hospitals?

According to CMS data, Jacob Connelly is affiliated with Los Alamos Medical Center.

When was this NPI record last updated?

The NPPES record for Jacob Connelly was last updated on August 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months 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.