Active NPI
Jackqulyn Brown
- Family Nurse Practitioner
- Southfield, MI
National Provider Identifier
1194591719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 4704342245
- Practice address
- 20755 Greenfield Rd Ste 100
Southfield, MI 48075-5400 - Phone
- (248) 557-0507
- NPI assigned
- Nov 27, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704342245 | MI | |
| Family Nurse Practitioner | 363LF0000X | 4704342245 | MI | Primary |
Addresses
Primary practice location
20755 Greenfield Rd Ste 100
Southfield, MI 48075-5400
Mailing address
20755 Greenfield Rd Ste 100
Southfield, MI 48075-5400
Phone (313) 529-6050
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
21700 Northwestern Hwy 150
Southfield, MI 48075-4906
Hospital & facility affiliations
- Beaumont Hospital Royal Oak
- Beaumont Hospital - Farmington Hills
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704342245 | MI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| RSMD PLLC | Current | Accepting new patients | |
| Home Physicians of Michigan, PC | Past | Accepting new patients |
Locations
20755 Greenfield Rd
Ste 100
Southfield, MI 48075
Phone (248) 557-0507
Interoperability endpoints
- jbrown1119046@direct.hfhs.org
- jbrown1226976@epic00.shdirect.org
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 and National Provider Directory roles.
-
- Internal Medicine Physician
- Southfield, MI
- NPI 1053663575
-
- Health Service Clinic/Center
- Southfield, MI
- NPI 1295064434
Hospital & facility affiliations 11
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Farmington Hills, MI
- NPI 1336183367
-
- General Acute Care Hospital
- Troy, MI
- NPI 1306825997
-
- General Acute Care Hospital
- Royal Oak, MI
- NPI 1689653305
-
- General Acute Care Hospital
- Grosse Pointe, MI
- NPI 1932396017
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1194591719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20755 GREENFIELD RD STE 100",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480755400",
"telephone_number": "313-529-6050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20755 GREENFIELD RD STE 100",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480755400",
"telephone_number": "248-557-0507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "JACKQULYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-27",
"last_updated": "2023-11-27",
"certification_date": "2023-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704342245",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MI",
"license": "4704342245",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.