Active NPI
Jeffry Scott Freeman, PA
- Physician Assistant
- Portage, MI
National Provider Identifier
1285745950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601003249
- Practice address
- 3000 Old Centre Rd
Portage, MI 49024-4883 - Phone
- (269) 321-7546
- Fax
- (269) 321-1705
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601003249 | MI | Primary |
Addresses
Primary practice location
3000 Old Centre Rd
Portage, MI 49024-4883
Mailing address
3000 Old Centre Rd
Portage, MI 49024-4883
Phone (269) 321-7546
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 070C910440 | Other | MI | BLUE CROSS & BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401753600000",
"number": "1285745950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 OLD CENTRE RD",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490244883",
"telephone_number": "269-321-7546",
"fax_number": "269-321-1705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 OLD CENTRE RD",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490244883",
"telephone_number": "269-321-7546",
"fax_number": "269-321-1705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREEMAN",
"first_name": "JEFFRY",
"middle_name": "SCOTT",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2014-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601003249",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "070C910440",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portage, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.