Active NPI
Susan Emily Jevert-Eichorn, DO
- Family Medicine Physician
- Otsego, MI
National Provider Identifier
1053756510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101020470
- Practice address
- 900 Dix St Ste 300
Otsego, MI 49078-1544 - Phone
- (269) 276-4347
- Fax
- (269) 496-3041
- NPI assigned
- May 9, 2013
- Last updated
- Dec 19, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101020470 | MI | Primary |
Addresses
Primary practice location
900 Dix St Ste 300
Otsego, MI 49078-1544
Mailing address
900 Dix St Ste 300
Otsego, MI 49078-1544
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5390367 | Other | MI | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 1, 2022 through May 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101020470 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michigan State University Kalamazoo Center for Medical Studies | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Msu/KCMS
- Multi-Specialty Clinic/Center
- Kalamazoo, MI
- NPI 1568467249
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702944000000",
"number": "1053756510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 DIX ST STE 300",
"city": "OTSEGO",
"state": "MI",
"postal_code": "490781544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 DIX ST STE 300",
"city": "OTSEGO",
"state": "MI",
"postal_code": "490781544",
"telephone_number": "269-276-4347",
"fax_number": "269-496-3041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEVERT-EICHORN",
"first_name": "SUSAN",
"middle_name": "EMILY",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-09",
"last_updated": "2023-12-19",
"certification_date": "2023-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5101020470",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "5390367",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Otsego, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.