Individual provider Active NPI

Jacob Arthur Livermore, M.D.

  • Diagnostic Radiology Physician
  • Ypsilanti, MI
National Provider Identifier
1174649206
Registry record updated Aug 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
4301083916 Issued in MI
Practice address
5333 McAuley Dr
Suite 6016
Ypsilanti, MI 48197-1014
Phone
(734) 712-8350
Fax
(734) 712-8351
NPI assigned
Mar 21, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4301083916 MI
Diagnostic Radiology Physician 2085R0202X 4301083916 MI Primary

Addresses

Primary practice location

5333 McAuley Dr
Suite 6016
Ypsilanti, MI 48197-1014

Mailing address

5333 McAuley Dr
Suite 6016
Ypsilanti, MI 48197-1014
Phone (734) 712-8350

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090720000523 MI Practitioner - Diagnostic Radiology 0042362162 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Wayne State University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
X-Ray Consultants IncGroup PAC ID 7315859832, 38 clinicians
Huron Valley Radiology PCGroup PAC ID 2961466859, 76 clinicians

Practice addresses (Care Compare)

Plymouth, MI 48170
Phone (734) 712-8359

5333 McAuley Dr
RM 6016
Ypsilanti, MI 48197-1005
Phone (734) 712-8350

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Huron Valley Radiology PC Diagnostic Radiology CurrentSince Jun 23, 2010 Accepting new patients
X-Ray Consultants Inc Diagnostic Radiology CurrentSince Oct 1, 2022 Accepting new patients

Locations

7575 Grand River Rd
Ste 103
Brighton, MI 48114
Phone (866) 522-8268

44405 Woodward Ave
#202
Pontiac, MI 48341
Phone (248) 858-3000

44405 Woodward Ave
Pontiac, MI 48341
Phone (248) 858-3000

5303 Elliott Dr
#2661
Ypsilanti, MI 48197
Phone (734) 712-0280

5333 McAuley Dr
Rm 6016
Ypsilanti, MI 48197

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377820800000",
    "number": "1174649206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5333 MCAULEY DR",
            "address_2": "SUITE 6016",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971014",
            "telephone_number": "734-712-8350",
            "fax_number": "734-712-8351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5333 MCAULEY DR",
            "address_2": "SUITE 6016",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971014",
            "telephone_number": "734-712-8350",
            "fax_number": "734-712-8351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVERMORE",
        "first_name": "JACOB",
        "middle_name": "ARTHUR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2013-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301083916",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301083916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.