Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob William Raifstanger, PHYSICIANASSISTANT

Individual provider Surgical Physician Assistant · NPI 1679989479

Jacob William Raifstanger, PHYSICIANASSISTANT is a Physician Assistant in Rochester, New York. Qualified in 2014, 12 years ago. Practices with University of Vermont Medical Center Inc, a 1,202-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in New York.

Years since qualifying
12
Licensed in
NY
In the registry since
2014
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Practice location Address checks out

2655 Ridgeway Ave Ste 460
Rochester, NY 14626-4296
Phone: (585) 581-6790
Fax: (585) 581-6793
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1425 Portland Ave, Rochester, NY 14621-3001 — (585) 922-3458

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 017837 (NY)

Record details

NPI number1679989479
Entity typeIndividual (Type 1)
GenderMale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedJuly 1, 2014
Last updated in NPPESJanuary 11, 2023
Certification dateJanuary 11, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice University Of Vermont Medical Center Inc — 1202 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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