Jillian N Petkus, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704266490 Issued in MI

Practice address

72 S Washington St
Oxford, MI 48371-6421

Phone

(248) 236-8333

Fax

(248) 236-8666

NPI assigned

Jul 30, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jpetkus@direct.dmc.org

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.

• Oxford Urgent Care P L C

  • Specialist
  • Oxford, MI
  • NPI 1700036936
  Medicare reassignment NPD
• Hometown Urgent Care of Michigan, P.C.

  • Urgent Care Clinic/Center
  • Huber Heights, OH
  • NPI 1790030385

  MI

  Medicare reassignment
• Hometown Urgent Care of Michigan, P.C.

  • Clinical Medical Laboratory
  • Kalamazoo, MI
  • NPI 1891469631
  NPD

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

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407283200000",
    "number": "1174879951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E AUBURN RD",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483075260",
            "telephone_number": "248-853-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 S WASHINGTON ST",
            "city": "OXFORD",
            "state": "MI",
            "postal_code": "483716421",
            "telephone_number": "248-236-8333",
            "fax_number": "248-236-8666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETKUS",
        "first_name": "JILLIAN",
        "middle_name": "N",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-30",
        "last_updated": "2014-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704266490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700036936",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Pauls
• Jessica Ann Lake Pearson, RN
• Julie Christine Perry, PT
• Lydia Mae Perry, MA TLLP
• Elizabeth Ann Peruski, D.P.T., A.T.C.
• Brittany Pietsch
• Jamie Pittenger
• Kelly Kendra Pizzo, LMSW
• Taylor Pode, DPT
• Lindsay Dewitte Politowicz, MA, LLC

• Family Nurse Practitioner in Oxford, MI
• Providers in Oxford, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.