Individual provider Active NPI

John David Fisher, PA-C

  • Physician Assistant
  • Detroit, MI
National Provider Identifier
1225753775
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4001 W McNichols Rd
Detroit, MI 48221-3038
Phone
(313) 993-1245
NPI assigned
Oct 6, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

4001 W McNichols Rd
Detroit, MI 48221-3038

Mailing address

417 Kerby Rd
Grosse Pointe Farms, MI 48236-2921
Phone (313) 283-9317

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
I20221228001591 MI Practitioner - Physician Assistant 0648640193 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pic Indiana PCGroup PAC ID 3476790239, 143 clinicians

Practice addresses (Care Compare)

1131 M 32
Alpena, MI 49707-8222
Phone (989) 250-1925

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hometown Urgent Care of Michigan, PC CurrentSince Jan 23, 2023 Accepting new patients
Hometown Urgent Care of Michigan, P.C. CurrentSince Jan 23, 2023 Accepting new patients
Hometown Urgent Care of Michigan, P.C. Current Accepting new patients
University of Detroit Mercy PastSince Oct 9, 2022 Accepting new patients

Locations

1131 M 32 W
Alpena, MI 49707
Phone (989) 250-1925

1634 Gull Rd
Kalamazoo, MI 49048
Phone (269) 903-2835

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1665014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1225753775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 KERBY RD",
            "city": "GROSSE POINTE FARMS",
            "state": "MI",
            "postal_code": "482362921",
            "telephone_number": "313-283-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482213038",
            "telephone_number": "313-993-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-06",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.