Mackenzie Jacks, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601007103 Issued in MI

Practice address

3040 E 7 Mile Rd
Detroit, MI 48234-1662

Phone

(313) 368-0705

NPI assigned

Apr 17, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Park Family Health Care, P.C.

  • Family Medicine Physician
  • Detroit, MI
  • NPI 1437161437
  Medicare reassignment

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

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422921600000",
    "number": "1285054254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 E 7 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482341662",
            "telephone_number": "313-368-0705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 E 7 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482341662",
            "telephone_number": "313-368-0705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKS",
        "first_name": "MACKENZIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-17",
        "last_updated": "2015-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorelee Jacinto, P.T.
• Chaun Rene Jack
• Jackies Guardian Angels LLC.
• Catherine Brock Jackman, ACNS-BC
• Latoya T Jackosn, COUNSELOR
• Tameka Latoya Jackson -Dyer, IBCLC, CHW
• Phazhe Jackson Dorr
• Jackson Health Services
• Jackson Health Services
• Taylour D Jackson Knight

• Physician Assistant in Detroit, MI
• Providers in Detroit, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2015; 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.

Verify at the official NPI Registry.