NPIMap

Individual provider Active NPI

Jawan Gorgis, MD

  • Family Medicine Physician
  • Rochester Hills, MI
National Provider Identifier
1265960579
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301112062 Issued in MI
Practice address
1202 Walton Blvd Ste 216
Rochester Hills, MI 48307-6917
Phone
(248) 710-3023
NPI assigned
May 31, 2017
Last updated
Oct 20, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301112062 MI Primary

Addresses

Primary practice location

1202 Walton Blvd Ste 216
Rochester Hills, MI 48307-6917

Mailing address

1202 Walton Blvd Ste 216
Rochester Hills, MI 48307-6917
Phone (248) 710-3033

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jgorgis461964@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200708003460 MI Practitioner - Family Practice 3274804125 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians

Practice addresses (Care Compare)

1202 Walton Blvd
216 Corewell Health Family Medicine
Rochester Hills, MI 48307-6917
Phone (248) 710-3023

201 3Rd St
Suite 200
Belleville, MI 48111-2605
Phone (734) 697-9065

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory, LLC CurrentSince Jul 31, 2020 Accepting new patients
Oakwood Ambulatory LLC Family Medicine CurrentSince Jul 31, 2020 Accepting new patients
William Beaumont Hospital Past Accepting new patients

Locations

201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065

1202 Walton Blvd
Ste 216
Rochester Hills, MI 48307
Phone (248) 656-2022

44250 Dequindre Rd
Sterling Hts, MI 48314
Phone (248) 964-0400

Interoperability endpoints

  • Direct secure messaging: jgorgis461964@direct.beaumont.edu
  • Direct secure messaging: jgorgis360093@direct.hfhs.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1265960579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 WALTON BLVD STE 216",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483076917",
            "telephone_number": "248-710-3033",
            "fax_number": "248-266-6058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 WALTON BLVD STE 216",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483076917",
            "telephone_number": "248-710-3023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORGIS",
        "first_name": "JAWAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-31",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301112062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgorgis461964@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "1202 Walton Blvd Ste 216",
            "city": "Rochester Hills",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483076917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rochester Hills, MI

Sources for this page

Verify at the official NPI Registry.