Active NPI
Jackson Health Services
- Clinic/Center
- Detroit, MI
National Provider Identifier
1205090354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- License
- 4301046737
- Legal business name
- JACKSON HEALTH SERVICES
- Practice address
- 3800 Woodward Ave
Ste. 418
Detroit, MI 48201-2061 - Phone
- (313) 831-8805
- Fax
- (313) 832-8206
- NPI assigned
- Jul 17, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mary L. Jackson-Hammond, M.D.
- Title
- Medical Director
- Phone
- (313) 831-8805
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 4301046737 | MI | Primary |
Addresses
Primary practice location
3800 Woodward Ave
Ste. 418
Detroit, MI 48201-2061
Mailing address
3800 Woodward Ave
Ste. 418
Detroit, MI 48201-2061
Phone (313) 831-8805
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4180604 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Jackson Health Services
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Medicine Physician
- Detroit, MI
- NPI 1093134348
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Detroit, MI
- NPI 1215015680
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216252800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1216252800000",
"number": "1205090354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3800 WOODWARD AVE",
"address_2": "STE. 418",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012061",
"telephone_number": "313-831-8805",
"fax_number": "313-832-8206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 WOODWARD AVE",
"address_2": "STE. 418",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012061",
"telephone_number": "313-831-8805",
"fax_number": "313-832-8206"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JACKSON HEALTH SERVICES",
"organizational_subpart": "NO",
"enumeration_date": "2008-07-17",
"last_updated": "2008-07-17",
"status": "A",
"authorized_official_last_name": "JACKSON-HAMMOND",
"authorized_official_first_name": "MARY",
"authorized_official_middle_name": "L.",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "313-831-8805",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "MI",
"license": "4301046737",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4180604",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; 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.