Jacob Fitzpatrick

Key facts

NPI

1114505807

Entity type

Individual (NPI type 1)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

4704336069 (MI)

Practice address

5830 N Lapeer Rd Ste B&C
North Branch, MI 48461-9660

Phone

(810) 545-0235

NPI assigned

Apr 1, 2021

Sex

Male

Sole proprietor

No

Organizations & group practices 2

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.

• Carelon Medical Partners, PC Hospice and Palliative Medicine (Internal Medicine) Physician · Nashville, TN · NPI 1124443403
  Medicare reassignment WI
• Caremore Health Medical Partners, PC Internal Medicine Physician · Indianapolis, IN · NPI 1124640503
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

Practice roles

Interoperability endpoints

• Direct secure messaging: jfitzpatrick548585@direct.hfhs.org
• Direct secure messaging: jfitzpatrick20174@carelonhealth.direct-ci.com

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 1, 2021.

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1114505807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5830 N LAPEER RD STE B-D",
            "city": "NORTH BRANCH",
            "state": "MI",
            "postal_code": "484619660",
            "telephone_number": "810-545-0235",
            "fax_number": "810-545-0409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5830 N LAPEER RD STE B&C",
            "city": "NORTH BRANCH",
            "state": "MI",
            "postal_code": "484619660",
            "telephone_number": "810-545-0235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZPATRICK",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-01",
        "last_updated": "2021-04-01",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704336069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Branch, MI

• Dental Health Care
• Antonio Dicarlo
• Donald J. Brockriede, D.D.S., P.C.
• Ehardt'S Pharmacy Inc.
• Debra Ann Emery
• Megen Forster
• Full Circle Physical Therapy Inc
• GRS Care Management, LLC
• Huron Street Pharmacy
• Saige Alyss Jager

All providers in North Branch, MI · Family Nurse Practitioner in Michigan