Jennifer R Idrissu, NP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

4704245483 Issued in MI

Practice address

3455 Starr Rd
Royal Oak, MI 48073-2100

Phone

(248) 288-9340

Fax

(248) 965-3029

NPI assigned

Apr 22, 2020

Last updated

Jun 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jennifer R Johnson Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jjohnson140783@direct.hfhs.org

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.

• Henry Ford Health System

  • Nurse Practitioner
  • Detroit, MI
  • NPI 1104900455
  Medicare reassignment Care Compare group NPD
• Michigan Kidney Consultants, P.C.

  • Nephrology Physician
  • Sterling Heights, MI
  • NPI 1831130723
  Medicare reassignment NPD
• Henry Ford Health System

  • Community/Retail Pharmacy
  • Plymouth, MI
  • NPI 1942931720
  NPD

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

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Care Compare affiliation

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

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1053931873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5280 METROPOLITAN PKWY",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483104005",
            "telephone_number": "248-290-3111",
            "fax_number": "248-290-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 STARR RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480732100",
            "telephone_number": "248-288-9340",
            "fax_number": "248-965-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDRISSU",
        "first_name": "JENNIFER",
        "middle_name": "R",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-22",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704245483",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "4704245483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "JOHNSON",
            "middle_name": "R",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amjad Ibrahim
• Mohammed Ibrahim, MD
• Ragheda Ibrahim
• Ida Zektick Zack PHD PLLC
• Jay Idler
• Alexandria L Idziak
• Hira Iftikhar, MD
• Maureen Nkolika Ikedinobi-Ndi, MD
• Kamala Rajni Ilg
• Patricia Imai

• Primary Care Nurse Practitioner in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Primary Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.