Individual provider Active NPI

Jacob Michael Burke

  • Emergency Medicine Physician
  • Detroit, MI
National Provider Identifier
1013413673
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4301503928 Issued in MI
Practice address
6071 W Outer Dr
Detroit, MI 48235-2624
Phone
(313) 966-1020
NPI assigned
Apr 3, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4301503928 MI Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

6071 W Outer Dr
Detroit, MI 48235-2624

Mailing address

1395 Antietam Ave Apt 59
Detroit, MI 48207-2875
Phone (586) 246-1645

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210928001309 IL Practitioner - Emergency Medicine 6800141649 Reassigns benefits to 3 organizations
I20211012000755 MI Practitioner - Emergency Medicine 6800141649 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Wayne State University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hawk Emergency Group, P.C.Group PAC ID 6800241050, 55 clinicians
Interlochen Emergency Group PCGroup PAC ID 3577918606, 49 clinicians

Practice addresses (Care Compare)

1100 E Michgan Ave
Grayling, MI 49738-1312
Phone (989) 348-5461

1105 6TH St
Traverse City, MI 49684-2345
Phone (231) 935-5000

Hospital & facility affiliations

  • Munson Healthcare Grayling Hospital Hospital, Grayling, MI, CCN 230058

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Caberfae Emergency Group, P.C. Emergency Medicine CurrentSince Nov 1, 2023 Accepting new patients
Hawk Emergency Group, P.C. Emergency Medicine CurrentSince Nov 1, 2023 Accepting new patients
Interlochen Emergency Group, P.C. Emergency Medicine CurrentSince May 1, 2025 Accepting new patients
Midwest Emergency Sparta, Inc Emergency Medicine CurrentSince Sep 15, 2021 Accepting new patients
Midwest Emergency Good Samaritan, Inc Emergency Medicine CurrentSince Sep 15, 2021 Accepting new patients
Midwest Emergency Centralia Campus Associates, Inc Emergency Medicine CurrentSince Sep 15, 2021 Accepting new patients

Locations

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

1 Good Samaritan Way
Mount Vernon, IL 62864
Phone (618) 242-4600

818 E Broadway St
Sparta, IL 62286
Phone (618) 443-2177

400 Hobart St
Cadillac, MI 49601
Phone (231) 876-7200

14700 Lake Shore Dr
Charlevoix, MI 49720
Phone (231) 547-3840

1100 E Michigan Ave
Grayling, MI 49738
Phone (989) 348-0317

1465 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1000

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

Organizations & group practices 6

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 1

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": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1013413673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 ANTIETAM AVE APT 59",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482072875",
            "telephone_number": "586-246-1645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6071 W OUTER DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482352624",
            "telephone_number": "313-966-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKE",
        "first_name": "JACOB",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301503928",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.