Individual provider Active NPI

J A Pecsok, DC

  • Chiropractor
  • Warren, MI
National Provider Identifier
1104968759
Registry record updated Apr 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
JP002473 Issued in MI
Practice address
26493 Hoover
Warren, MI 48090-1228
Phone
(586) 757-6200
Fax
(586) 757-8605
NPI assigned
Feb 12, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X JP002473 MI Primary

Addresses

Primary practice location

26493 Hoover
Warren, MI 48090-1228

Mailing address

26493 Hoover PO Box 1228
Warren, MI 48090-1228
Phone (586) 757-6200

Other identifiers 2

IdentifierTypeStateIssuer
0E03864OtherMIBLUE CROSS
950E05148OtherMIBCBS MI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131202001235 MI Practitioner - Chiropractic 4587852223 Practice locations: Warren, MI

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1968
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

26493 Hoover Rd
Warren, MI 48089-1102
Phone (586) 757-6200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2473MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Sargent Chiropractic Clinic PLLC Chiropractor Current 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364774400000",
    "number": "1104968759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26493 HOOVER PO BOX 1228",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480901228",
            "telephone_number": "586-757-6200",
            "fax_number": "586-757-8605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26493 HOOVER",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480901228",
            "telephone_number": "586-757-6200",
            "fax_number": "586-757-8605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECSOK",
        "first_name": "J",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2013-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "JP002473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0E03864",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MI",
            "identifier": "950E05148",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.