Active NPI
Jessica Nicole Humphrey, PA-C
- Surgical Physician Assistant
- Redford TWP, MI
National Provider Identifier
1083865398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 5601005400
- Practice address
- 15540 Beech Daly Rd
Midwest Urgent Care
Redford TWP, MI 48239 - Phone
- (313) 592-6330
- NPI assigned
- Oct 6, 2008
- Last updated
- Nov 24, 2014
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 5601005400 | MI | Primary |
Addresses
Primary practice location
15540 Beech Daly Rd
Midwest Urgent Care
Redford TWP, MI 48239
Mailing address
31360 Northwestern Hwy
Wendy Sadoff MD Dermatology PC
Farmington Hills, MI 48334
Phone (248) 855-3300
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601005400 | MI | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416787200000",
"number": "1083865398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31360 NORTHWESTERN HWY",
"address_2": "WENDY SADOFF MD DERMATOLOGY PC",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "48334",
"telephone_number": "248-855-3300",
"fax_number": "248-855-3319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15540 BEECH DALY RD",
"address_2": "MIDWEST URGENT CARE",
"city": "REDFORD TWP",
"state": "MI",
"postal_code": "48239",
"telephone_number": "313-592-6330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUMPHREY",
"first_name": "JESSICA",
"middle_name": "NICOLE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-06",
"last_updated": "2014-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "MI",
"license": "5601005400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redford TWP, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.