NPIMap

Individual provider Active NPI

Kristan Gail Jenkins-Mosure, M.D.

  • Diagnostic Radiology Physician
  • Detroit, MI
National Provider Identifier
1013145853
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
4301088572 Issued in MI
Practice address
2799 W Grand Blvd
Detroit, MI 48202-2608
Phone
(800) 653-6568
NPI assigned
Jul 1, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X 4301088572 MI
Body Imaging Physician 2085B0100X 35098978 OH
Diagnostic Radiology Physician 2085R0202X 35098978 OH
Diagnostic Radiology Physician 2085R0202X 4301088572 MI Primary

Addresses

Primary practice location

2799 W Grand Blvd
Detroit, MI 48202-2608

Mailing address

2213 Cherry St
Attn: MRG Associates, LLC - Radiology Dept.
Toledo, OH 43608-2603
Phone (419) 251-2740

Other practice location 1

2213 Cherry St
ATTN: MRG Associates, LLC - Radiology Dept.
Toledo, OH 43608-2603
Phone (419) 251-2740

Other identifiers 2

IdentifierTypeStateIssuer
35098978OtherOHOH MEDICAL LICENSE
0067438MedicaidOH

Other names 1

  • Kristan Gail Jenkins Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110616000719 MI Practitioner - Diagnostic Radiology 8820276041 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Wayne State University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians
Henry Ford Urgent CareGroup PAC ID 6901296110, 111 clinicians
Troy Internal Medicine, PCGroup PAC ID 0840282067, 42 clinicians

Practice addresses (Care Compare)

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

30795 23 Mile Rd
Chesterfield, MI 48047-5720
Phone (586) 421-3000

4600 Investment Dr
Troy, MI 48098-6368
Phone (248) 267-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301088572MIMDBody Imaging Physician
35098978OHMDBody Imaging Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Macomb Hospital Corporation Current Accepting new patients
Henry Ford Macomb Hospital Corporation Diagnostic Radiology CurrentSince Jan 1, 2020 Accepting new patients
Henry Ford Health System Diagnostic Radiology CurrentSince Jul 1, 2011 Accepting new patients
Henry Ford Urgent Care CurrentSince Feb 1, 2022 Accepting new patients
Troy Internal Medicine, PC CurrentSince May 1, 2021 Accepting new patients
Henry Ford Health System CurrentSince Jul 1, 2011 Accepting new patients
Henry Ford Health System Current Accepting new patients
Henry Ford Macomb Hospital Corporation Diagnostic Radiology CurrentSince Jan 1, 2020 Accepting new patients

Locations

80650 Van Dyke Rd
Bruce Twp, MI 48065
Phone (810) 798-6410

30795 23 Mile Rd
Chesterfield, MI 48047
Phone (586) 421-3000

15717 15 Mile Rd
Clinton Twp, MI 48035
Phone (586) 285-3800

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2300

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

4600 Investment Dr
Ste 300
Troy, MI 48098
Phone (248) 267-5000

Interoperability endpoints

  • Direct secure messaging: kjenkinsmosure365635@direct.hfhs.org

Organizations & group practices 8

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1013145853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2213 CHERRY ST",
            "address_2": "ATTN: MRG ASSOCIATES, LLC - RADIOLOGY DEPT.",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436082603",
            "telephone_number": "419-251-2740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "800-653-6568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2213 Cherry St",
            "address_2": "ATTN: MRG Associates, LLC - Radiology Dept.",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436082603",
            "country_code": "US",
            "telephone_number": "419-251-2740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENKINS-MOSURE",
        "first_name": "KRISTAN",
        "middle_name": "GAIL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-01",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "MI",
            "license": "4301088572",
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "OH",
            "license": "35098978",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35098978",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301088572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OH MEDICAL LICENSE",
            "identifier": "35098978",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0067438",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTAN",
            "last_name": "JENKINS",
            "middle_name": "GAIL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.