Michael S Jakubowski, M.D.
Individual provider Active NPI Physical Medicine & Rehabilitation Physician · Grand Rapids, MI
NPI 1104863646 · NPPES record last updated Dec 11, 2013
Key facts
- NPI
- 1104863646
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- License
- MJ043600 (MI)
- Practice address
- 350 Lafayette Ave SE
Suite 301
Grand Rapids, MI 49503-4656 - Phone
- (616) 459-0801
- Fax
- (616) 459-4065
- NPI assigned
- Jun 1, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Owned or controlled facilities with NPI records 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Mary Free Bed Rehabilitation Hospital |
Hospital | Corporate Director | Aug 3, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090709000610 | MI | Practitioner - Physical Medicine and Rehabilitation | 0244387660 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MJ043600 | MI | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advantage Health/Saint Mary'S Medical Group | Current | Accepting new patients | |
| Mary Free Bed Rehabilitation Hospital | Current |
Accepting new patients | |
| Advantage Health Saint Mary'S Medical Group | Current |
Accepting new patients | |
| Mary Free Bed Rehabilitation Hospital | Current |
Accepting new patients | |
| Advantage Health Saint Mary'S Medical Group | Current |
Accepting new patients | |
| Metropolitan Hospital | Past | Accepting new patients | |
| Rehabilitation & Physical Medicine Specialists, P.C. | Physical Medicine & Rehabilitation | Past |
Accepting new patients |
Locations
10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850
235 Wealthy St SE
Ste 100
Grand Rapids, MI 49503
Phone (616) 493-9724
1155 East Paris Ave SE
Ste 200
Grand Rapids, MI 49546
Phone (616) 233-3480
350 Lafayette Ave SE
Ste 301
Grand Rapids, MI 49503
Phone (616) 459-0801
235 Wealthy St SE
Grand Rapids, MI 49503
Phone (616) 242-0422
Interoperability endpoints
- mjakubowski582722@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | MJ043600 | MI | |
| Physical Medicine & Rehabilitation Physician | 208100000X | MJ043600 | MI | Yes |
Addresses
Primary practice location
350 Lafayette Ave SE
Suite 301
Grand Rapids, MI 49503-4656
Mailing address
350 Lafayette Ave SE
Suite 301
Grand Rapids, MI 49503-4656
Phone (616) 459-0801
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MJ043600 | Other | MI | STATE LICENSE |
| 1839854 | Medicaid | MI |
Other providers in Grand Rapids, MI
- Aruna Jain
- Ranu Jain
- Subodh Jain
- Paul Michael Jaklitsch
- Djordje Jaksic
- Christopher Troy Jalacki
- Sarah Emily Jaley
- James C. Papp, DMD, PLC
- James L. Wieland,D.D.S.,P.L.C.
- James R. Kosiur, D.O., P.C.
All providers in Grand Rapids, MI · Physical Medicine & Rehabilitation Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.