Active NPI
Justin Jickess
- Student in an Organized Health Care Education/Training Program
- Ypsilanti, MI
National Provider Identifier
1245934678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 5333 McAuley Drive
Suite 2115
Ypsilanti, MI 48197-8633 - Phone
- (734) 712-3971
- NPI assigned
- Mar 29, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
5333 McAuley Drive
Suite 2115
Ypsilanti, MI 48197-8633
Mailing address
500 E Regency Cir
Canfield, OH 44406-9643
Phone (330) 502-5005
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230809000708 | MI | Order and Referring Only - General Surgery | 0446612329 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680048000000",
"number": "1245934678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 E REGENCY CIR",
"city": "CANFIELD",
"state": "OH",
"postal_code": "444069643",
"telephone_number": "330-502-5005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5333 MCAULEY DRIVE",
"address_2": "SUITE 2115",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481978633",
"telephone_number": "734-712-3971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JICKESS",
"first_name": "JUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-29",
"last_updated": "2023-03-29",
"certification_date": "2023-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ypsilanti, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.