Shane Saji Jacob, PA
NPI 1609484468ActiveIndividual· Physician Assistant· Elmhurst, NY
Physician Assistant (PA) with Divinity Medical Services PLLC, practicing in Elmhurst, New York. 447 Medicare patients in 2024, $51,366 paid; nearly all of their 678 Part D prescriptions were generic (92%).
Overview
| NPI | 1609484468 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PA |
| Sole proprietor | No |
| NPI issued | Jul 17, 2020 |
| Last updated in NPPES | Feb 26, 2021 |
| Certified by provider | Feb 26, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | 025732 | NY |
| Physician Assistant | 363A00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (NY) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 447 |
|---|---|
| Services billed | 1,179 across 49 procedure codes |
| Paid by Medicare | $51,366 |
Part D prescriptions in 2024
| Prescriptions (claims) | 678 · 700 30-day fills |
|---|---|
| Patients | 478 |
| Total drug cost | $9,286 |
| Generic share | 92% of claims |
Education and affiliations
| Graduation year | 2020 |
|---|---|
| Medicare specialty | Physician Assistant |
Medical group
- Divinity Medical Services PLLCYorktown Heights, NY · 94 clinicians
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 149 physician assistants in Elmhurst · All physician assistants in New York