Jacquelyn Gillum

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

AS810014833 Issued in MI

Practice address

1132 Clair Circle
P.O.
Ann Arbor, MI 48103-4810

Phone

(734) 545-0188

NPI assigned

Dec 22, 2018

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Henlyn Care, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Ann Arbor, MI
  • NPI 1942865720
  NPD (past) Authorized official

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

{
    "created_epoch": "1545436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545436800000",
    "number": "1295207686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1132 CLAIR CIR # PO",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481033023",
            "telephone_number": "734-663-9080",
            "fax_number": "734-663-9080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 CLAIR CIRCLE",
            "address_2": "P.O.",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481034810",
            "telephone_number": "734-545-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLUM",
        "first_name": "JACQUELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-22",
        "last_updated": "2018-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "MI",
            "license": "AS810014833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney L Gillis, BCBA
• Margaret E Gillis, MD
• Mary Katherine Gillis, M.S.
• Brooke Gillispie
• Stephanie Catherine Gillman, PA-C
• Robert Harris Gilman, MD
• Sid Gilman, MD
• Amanda Louise Gilmore, CRNA
• Kathleen Mary Gilmore, MD
• Steven Logan Gilpin, LMSW

• All providers in Ann Arbor, MI
• Community Health Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.