Active NPI
Amelia Jackson
- Home Health Aide
- Dearborn, MI
National Provider Identifier
1134549751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- E4197J
- Practice address
- 23636 Michigan Ave # 487
Dearborn, MI 48124-1910 - Phone
- (419) 788-1199
- Fax
- (313) 914-5853
- NPI assigned
- Apr 22, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Companion | 372600000X | E4197J | MI | |
| Home Health Aide | 374U00000X | E4197J | MI | Primary |
| Nurse's Aide | 376K00000X | E4197J | MI |
Addresses
Primary practice location
23636 Michigan Ave # 487
Dearborn, MI 48124-1910
Mailing address
23636 Michigan Ave # 487
Dearborn, MI 48124-1910
Phone (419) 788-1199
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E4197J | MI | MD | Adult Companion |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398124800000",
"number": "1134549751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23636 MICHIGAN AVE # 487",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481241910",
"telephone_number": "419-788-1199",
"fax_number": "313-914-5853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23636 MICHIGAN AVE # 487",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481241910",
"telephone_number": "419-788-1199",
"fax_number": "313-914-5853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "AMELIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-22",
"last_updated": "2014-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": "MI",
"license": "E4197J",
"primary": false
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "MI",
"license": "E4197J",
"primary": true
},
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "MI",
"license": "E4197J",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 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.