NPIMap

Organization Active NPI

Jagannathan Neurosurgical Institute PLLC

  • Neurological Surgery Physician
  • Bay City, MI
National Provider Identifier
1154969004
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC
Practice address
4 Columbus Ave Ste 260
Bay City, MI 48708-6476
Phone
(989) 308-1840
Fax
(989) 391-4170
NPI assigned
Dec 11, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Jayant Jagannathan, MDNPI 1558578708
Title
President
Phone
(248) 792-6527

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

4 Columbus Ave Ste 260
Bay City, MI 48708-6476

Mailing address

Dept 771749 PO Box 77000
Detroit, MI 48277-2000
Phone (248) 792-6527

Other identifiers 1

IdentifierTypeStateIssuer
1356680912MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200225000450 MI DME Supplier - Physician - General Practice 9638317373 Practice locations: Bay City, MI

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Jagannathan Neurosurgical Institute PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3290 W Big Beaver Rd
Ste 150
Troy, MI 48084
Phone (248) 792-6527

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1576022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1154969004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 771749 PO BOX 77000",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482772000",
            "telephone_number": "248-792-6527",
            "fax_number": "248-792-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 COLUMBUS AVE STE 260",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487086476",
            "telephone_number": "989-308-1840",
            "fax_number": "989-391-4170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-11",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "JAGANNATHAN",
        "authorized_official_first_name": "JAYANT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-792-6527",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356680912",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.