Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1609484468 Individual Practitioner Male Practitioner

Shane Saji Jacob , PA

Physician Assistant • Elmhurst, NY

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Shane Jacob, PA is a certified Physician Assistant practicing in Elmhurst, NY. With approximately 6 years of clinical experience since completing medical education in 2020, Shane Jacob delivers high-quality medical care to the local community at 7901 BROADWAY.

Shane Jacob is affiliated with Divinity Medical Services Pllc and accepts Medicare assignment.

Frequently performed procedures and clinical services include established patient outpatient office visit, detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19), detection test by immunoassay with direct visual observation for influenza virus. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

7901 Broadway

Elmhurst, NY 113731329

Telephone 7183342480
Fax 7183342478
Associated Practice Facility / Clinic
🏢 Newtown Dialysis Center, Inc Facility NPI 1801883707

Medicare Profile & Education

Medical School

Other

Graduation Year

2020

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Elmhurst, NY

Experienced Practitioner (5-10 Yrs)
Practitioner Clinical Experience
6 Yrs -1.0 yrs vs City Avg
City Avg: 7.0 Yrs
State Avg: 12.0 Yrs
Regional Practice Density
147 Specialists

Practicing in Elmhurst, NY (15701 Statewide)

Telehealth Adoption Rate
3.4% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
49.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Jacob (6 Years) 6 Yrs
Elmhurst Specialty Average (7.0 Years) 7.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes
334 281 $210.85 $87.72
87811 Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19)
236 222 $82.76 $40.03
87804 Detection test by immunoassay with direct visual observation for influenza virus
184 92 $49.84 $15.87
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
107 105 $220.00 $122.39
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more
62 62 $211.61 $108.40
81003 Automated urinalysis test
32 28 $4.62 $2.20
87880 Detection test by immunoassay with direct visual observation for streptococcus, group a (strep)
32 31 $33.94 $15.69
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more
28 28 $291.06 $161.97
93000 Routine ekg using at least 12 leads including interpretation and report
14 14 $30.75 $14.08
87807 Detection test by immunoassay with direct visual observation for respiratory syncytial virus
12 12 $17.99 $12.84

Medical Specialties & State Licenses

CMS Verified: 2021-02-26
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License NY 025732

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.

Physician Assistant

NUCC Taxonomy Code: 363A00000X

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.

Hospital & Practice Group Affiliations

Divinity Medical Services Pllc

3379 Crompond Rd, Yorktown Heights, NY 105983605

Phone: 9149305550

Divinity Medical Services Pllc

2128 Rockaway Pkwy, Brooklyn, NY 112365802

Phone: 7184898820

Divinity Medical Services Pllc

1585 Dutch Broadway, Valley Stream, NY 115801333

Phone: 5164906300

Divinity Medical Services Pllc

464 Atlantic Ave, East Rockaway, NY 115181415

Phone: 5167303344

Divinity Medical Services Pllc

3400 Boston Rd, Bronx, NY 104692502

Phone: 7182908787

Divinity Medical Services Pllc

23315 Hillside Ave, Queens Village, NY 114272634

Phone: 7182101945

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners
Dr. Chaya Shwaartz , MD

Student in an Organized Health Care Education/Training Program

NPI 1295115632

Doctor of Medicine (M.D.)

Natalia Henao-Pena

Physician Assistant

NPI 1306489927
NPI 1386811875

Doctor of Medicine (M.D.)

Catrisha Duret , PA-C

Physician Assistant

NPI 1497392880

Physician Assistant (Certified)

Milana Cohen , PA

Physician Assistant

NPI 1629274253

Physician Assistant

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events
📍
Updated Practice Location February 26, 2021

Registered at 7901 BROADWAY, ELMHURST, NY 113731329 (Tel: 7183342480)

📍
Updated Business Mailing Address February 26, 2021

Registered at 7901 BROADWAY, ELMHURST, NY 113731329 (Tel: 7183342480)

📍
Updated Business Mailing Address August 31, 2020

Registered at 5707 S CASS AVE, WESTMONT, IL 605594800 (Tel: 0000000000)

NPI Profile Active July 17, 2020

NPI status registered as active in NPPES database

📍
Updated Practice Location July 17, 2020

Registered at 18W194 CLAREMONT DR, DARIEN, IL 605613640 (Tel: 6305060983)

📍
Updated Business Mailing Address July 17, 2020

Registered at 18W194 CLAREMONT DR, DARIEN, IL 605613640 (Tel: 6305060983)

👤
Provider Name / Credentials Updated July 17, 2020

Recorded as SHANE JACOB, PA

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 17, 2020

Physician Assistant

🟢
Initial NPI Registration & Enumeration July 17, 2020

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1609484468
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 17, 2020
Last Update: February 26, 2021
Sole Proprietor: No

Mailing Address

7901 Broadway

Elmhurst, NY 113731329

Phone: 7183342480

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.