Jennifer Supol, DO

Primary specialty

SpecialistTaxonomy code 174400000X

License

5101014945 Issued in MI

Practice address

31500 Telegraph Rd
105
Bingham Farms, MI 48025-4367

Phone

(248) 540-8700

Fax

(248) 540-8701

NPI assigned

Aug 9, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jennifersupol@southfield.allscriptsdirect.net
• Direct secure messaging: jsupol1154909@direct.hfhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southfield Pediatric Physicains

  • Specialist
  • Bingham Farms, MI
  • NPI 1548270424
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003826900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31500 TELEGRAPH RD",
            "address_2": "105",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254367",
            "telephone_number": "248-540-8700",
            "fax_number": "248-540-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31500 TELEGRAPH RD",
            "address_2": "105",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254367",
            "telephone_number": "248-540-8700",
            "fax_number": "248-540-8701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPOL",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "5101014945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha N Sulzer
• Sheetal Madhuri Sumbet
• Sunshine Home Care of Michigan, Inc.
• Sunshine Home Chore Provider Services, LLC
• Derek Suo
• Sharlene Susman
• Stephanie Sustaita
• Josephine Suthon-Jason
• Ja'Mya Suttles
• Emma Swales

• Specialist in Bingham Farms, MI
• Providers in Bingham Farms, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.