NPIMap

Individual provider Active NPI

Jack F Conner, MD

  • Diagnostic Radiology Physician
  • Toledo, OH
National Provider Identifier
1043673239
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
4301113352 Issued in MI
Practice address
5757 Park Center CT.
Toledo, OH 43615
Phone
(419) 474-4064
Fax
(419) 472-2772
NPI assigned
Apr 4, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 4301113352 MI Primary

Addresses

Primary practice location

5757 Park Center CT.
Toledo, OH 43615

Mailing address

5757 Park Center CT.
Toledo, OH 43615
Phone (419) 474-4064

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
I20210827000560 MI Practitioner - Diagnostic Radiology 6608161757 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Colorado School of Medicine, Denver, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Huron Valley Radiology PCGroup PAC ID 2961466859, 76 clinicians

Practice addresses (Care Compare)

5333 McAuley Dr
RM 6016
Ypsilanti, MI 48197-1005
Phone (734) 712-8350

Hospital & facility affiliations

  • Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156
  • Trinity Health Oakland Hospital Hospital, Pontiac, MI, CCN 230029
  • St Joe Mercy Hospital System Livonia Hospital, Livonia, MI, CCN 230002
  • Trinity Health Livingston Hospital Hospital, Howell, MI, CCN 230069
  • Chelsea Hospital Hospital, Chelsea, MI, CCN 230259

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301113352MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan Current Accepting new patients
Regents of the University of Michigan Diagnostic Radiology CurrentSince Jun 30, 2021 Accepting new patients
X-Ray Consultants Inc Diagnostic Radiology CurrentSince Apr 1, 2024 Accepting new patients
Huron Valley Radiology PC Diagnostic Radiology CurrentSince Jul 10, 2023 Accepting new patients
Metropolitan Hospital CurrentSince Apr 1, 2022 Accepting new patients
Regents of the University of Michigan CurrentSince Jun 30, 2021 Accepting new patients
Metropolitan Hospital Past Accepting new patients
Metropolitan Hospital Past Accepting new patients

Locations

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

1500 E Medical Center Dr
#D
Ann Arbor, MI 48109
Phone (734) 936-5823

7575 Grand River Rd
Ste 103
Brighton, MI 48114
Phone (866) 522-8268

44405 Woodward Ave
#202
Pontiac, MI 48341
Phone (248) 858-3000

44405 Woodward Ave
Pontiac, MI 48341
Phone (248) 858-3000

5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243

5303 Elliott Dr
#2661
Ypsilanti, MI 48197
Phone (734) 712-0280

5333 McAuley Dr
Rm 6016
Ypsilanti, MI 48197

5301 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-7246

Interoperability endpoints

  • Direct secure messaging: jconner595565@direct.hfhs.org
  • Direct secure messaging: jconner2747006@direct.trinity-health.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 5

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": "1459728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1043673239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5757 PARK CENTER CT.",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "43615",
            "telephone_number": "419-474-4064",
            "fax_number": "419-472-2772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 PARK CENTER CT.",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "43615",
            "telephone_number": "419-474-4064",
            "fax_number": "419-472-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNER",
        "first_name": "JACK",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-04",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301113352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.