Active NPI
Jamie Waller
- Case Manager/Care Coordinator
- Detroit, MI
National Provider Identifier
1043641624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 6803085419
- Practice address
- 882 Oakman Blvd
Detroit, MI 48238-3710 - Phone
- (248) 974-2363
- NPI assigned
- Dec 6, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 6803085419 | MI | Primary |
Addresses
Primary practice location
882 Oakman Blvd
Detroit, MI 48238-3710
Mailing address
882 Oakman
Detroit, MI 48238
Phone (248) 974-2363
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6803085419 | MI | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725840000000",
"number": "1043641624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "882 OAKMAN",
"city": "DETROIT",
"state": "MI",
"postal_code": "48238",
"telephone_number": "248-974-2363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "882 OAKMAN BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482383710",
"telephone_number": "248-974-2363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "JAMIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-06",
"last_updated": "2024-09-09",
"certification_date": "2024-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "MI",
"license": "6803085419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.