Jenna Marie Carter, PA-C
Individual provider Active NPI Physician Assistant · South Lyon, MI
NPI 1306503602 · NPPES record last updated Feb 22, 2024
Key facts
- NPI
- 1306503602
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601010811 (MI)
- Practice address
- 22024 Pontiac TRL
South Lyon, MI 48178-9410 - Phone
- (248) 437-2525
- NPI assigned
- Nov 21, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Specialists in Rehabilitation Medicine PC
Practice addresses (Care Compare)
9640 Commerce Rd
Suite 202
Commerce TWP, MI 48382-4168
Phone (248) 360-8660
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: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220114001883 | MI | Practitioner - Physician Assistant | 3779975172 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601010811 | MI | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601010811 | MI | Yes |
Addresses
Primary practice location
22024 Pontiac TRL
South Lyon, MI 48178-9410
Mailing address
22024 Pontiac TRL
South Lyon, MI 48178-9410
Phone (248) 437-2525
Other providers in South Lyon, MI
- Joshua Campbell
- Brian J Canadi
- Bryan Joseph Capen I
- Christa Milena Carlomusto
- Lauren Elizabeth Carney
- Jenna Cato
- Kadija Nazih Chamas
- Dave Chatel
- Taylor M Chiatalas
- Sue Ciochon
All providers in South Lyon, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2024. 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.