Nicholas Tyler Barjaktarovich, D.O.
Individual provider Active NPI Family Medicine Physician · Roseville, MI
NPI 1265826804 · NPPES record last updated Jan 7, 2021
Key facts
- NPI
- 1265826804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 5101021847 (MI)
- Practice address
- 30550 Utica Rd
Roseville, MI 48066-1528 - Phone
- (586) 771-0290
- Fax
- (586) 771-5450
- NPI assigned
- Mar 21, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Lake Erie College of Osteopathic Medicine, Erie, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- McLaren Macomb
Practice addresses (Care Compare)
30550 Utica Rd
Roseville, MI 48066-1528
Phone (586) 771-0290
Hospital & facility affiliations
- Residential Home Health
- McLaren Macomb
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180720002362 | MI | Practitioner - Family Practice | 4688987985 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McLaren Macomb | Family Medicine | Current |
Accepting new patients |
| McLaren Macomb | Past | Accepting new patients |
Locations
32901 23 Mile Rd
Ste 120
Chesterfield, MI 48047
Phone (586) 725-4604
37399 Garfield Rd
Ste 203
Clinton Twp, MI 48036
Phone (586) 228-2911
39373 Garfield Rd
Clinton Twp, MI 48038
Phone (586) 286-4880
21510 Harrington St
Ste 202
Clinton Twp, MI 48036
Phone (586) 791-5250
50 N Perry St
Pontiac, MI 48342
Phone (248) 338-5300
30550 Utica Rd
Roseville, MI 48066
Phone (586) 771-0290
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 5101021847 | MI | Yes |
Addresses
Primary practice location
30550 Utica Rd
Roseville, MI 48066-1528
Mailing address
30550 Utica Rd
Roseville, MI 48066-1528
Phone (586) 771-0290
Other practice location 1
50 N Perry St
Pontiac, MI 48342-2217
Phone (248) 338-5392
Other practice location 2
3003 S Baldwin Rd
Lake Orion, MI 48359
Phone (248) 391-9090
Other providers in Roseville, MI
- Maria Balleza
- Bancs & Kings Home Help Services L.L.C.
- Lamika Banks
- Luis Barbe
- Brian A. Barbish
- Denella Shavon Barker
- Joana Barth
- Lori Ann Bazzetta
- Melissa Beitel
- Keith Bellovich
All providers in Roseville, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.