Individual provider Active NPI

Jennifer Ann Layman Young, NP

  • Family Nurse Practitioner
  • Niles, MI
National Provider Identifier
1164764155
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
470195740 Issued in MI
Practice address
2002 S 11TH St
Niles, MI 49120-4074
Phone
(269) 687-0808
Fax
(269) 684-0199
NPI assigned
Mar 18, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 28142683A IN
Family Nurse Practitioner 363LF0000X 470195740 MI Primary

Addresses

Primary practice location

2002 S 11TH St
Niles, MI 49120-4074

Mailing address

2002 S 11TH St
Niles, MI 49120-4074
Phone (269) 687-0808

Other identifiers 2

IdentifierTypeStateIssuer
201178960MedicaidIN
1164764155MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL EPIC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140717002386 MI Practitioner - Nurse Practitioner 1254412349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeland Community Hospital WatervlietGroup PAC ID 7416942750, 66 clinicians

Practice addresses (Care Compare)

2002 S 11TH St
Niles, MI 49120-4074
Phone (269) 687-0200

Hospital & facility affiliations

  • Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
  • Corewell Health Watervliet Hospital Hospital, Watervliet, MI, CCN 230078

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28142683AINMDFamily Nurse Practitioner
470195740MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Community Hospital Watervliet CurrentSince Jun 23, 2014 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Jun 23, 2014 Accepting new patients
Lakeland Community Hospital Watervliet Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

7040 Red Arrow Hwy
Coloma, MI 49038
Phone (269) 468-4318

2002 S 11th St
#S
Niles, MI 49120
Phone (269) 687-0200

2002 S 11th St
Niles, MI 49120
Phone (269) 687-0200

Interoperability endpoints

  • Direct secure messaging: jyoung1272839@epic00.corewelldirect.org

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1363564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1164764155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 S 11TH ST",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491204074",
            "telephone_number": "269-687-0808",
            "fax_number": "269-684-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 S 11TH ST",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491204074",
            "telephone_number": "269-687-0808",
            "fax_number": "269-684-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAYMAN YOUNG",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-18",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28142683A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "470195740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201178960",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164764155",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EPIC",
            "affiliation": "N",
            "address_1": "2002 S 11th St",
            "city": "Niles",
            "state": "MI",
            "country_code": "US",
            "postal_code": "491204074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Niles, MI

Sources for this page

Verify at the official NPI Registry.