Jaclyn Summer Liston-Crandall, M.D.
Individual provider Active NPI Family Medicine Physician · Tekonsha, MI
NPI 1114145133 · NPPES record last updated Dec 16, 2014
Key facts
- NPI
- 1114145133
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4301089625 (MI)
- Practice address
- 2218 US Highway 27 N
Tekonsha, MI 49092-9261 - Phone
- (517) 767-4038
- Fax
- (517) 767-3427
- NPI assigned
- Apr 23, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 3
Owned or controlled facilities with NPI records 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Michigan Medical School, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Ella E M Brown Charitable Circle
Practice addresses (Care Compare)
200 N Madison St
Marshall, MI 49068-1143
Phone (269) 781-4271
Hospital & facility affiliations
- Oaklawn Hospital
- Insight Hospital and Medical Center Coldwater
- Bronson Methodist Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.06 of 100
- Quality
- 85.32
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 71.56
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
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 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Oaklawn Hospital |
Hospital | W-2 Managing Employee | Apr 18, 2021 |
| Oaklawn Hospice |
Hospice | Corporate Director | Apr 18, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070829000105 | MI | Practitioner - Family Practice | 4587756069 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ella E M Brown Charitable Circle | Current |
Accepting new patients | |
| Ella E M Brown Charitable Circle | Family Medicine | Current |
Accepting new patients |
| Ella E M Brown Charitable Circle | Past | Accepting new patients |
Locations
720 US Highway 27 N
Marshall, MI 49068
Phone (269) 781-6600
215 E Mansion St
Ste 2C
Marshall, MI 49068
Phone (269) 789-4386
215 E Mansion St
Ste 1E
Marshall, MI 49068
Phone (269) 781-3938
200 N Madison St
Marshall, MI 49068
Phone (269) 789-3921
2218 US Highway 27 N
Tekonsha, MI 49092
Phone (517) 767-4038
Interoperability endpoints
- summer.liston.crandall.1@9698.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301089625 | MI | Yes |
Addresses
Primary practice location
2218 US Highway 27 N
Tekonsha, MI 49092-9261
Mailing address
2218 US Highway 27 N
Tekonsha, MI 49092-9261
Phone (517) 767-4038
Other providers in Tekonsha, MI
- Tiffany M Burns
- Evans Drugs of Tekonsha LLC
- Sydney Hicks
- Chad Allen Hunt
- David L. Lambrix
- Mary Katherine Mills
- Christine Claire Nault
- Mehmiya Raghid
- Gabrielle Kay Seiler
- Gretchen Marie Stefanski
All providers in Tekonsha, MI · Family Medicine 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 16, 2014. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.