Active NPI
Jeanne Ann Livernois, AU.D.
- Audiologist
- Detroit, MI
National Provider Identifier
1316277114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 1601000152
- Practice address
- 2799 W Grand Blvd
Detroit, MI 48202-2608 - Phone
- (313) 916-3280
- NPI assigned
- Dec 30, 2009
- Last updated
- Jan 14, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | 1601000152 | MI | Primary |
Addresses
Primary practice location
2799 W Grand Blvd
Detroit, MI 48202-2608
Mailing address
3352 Paddington Dr
Troy, MI 48084-1241
Phone (248) 229-3508
Other names 1
- Jeanne Ann Fowler
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1601000152 | MI | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Ford Maplegrove Center | Past | Accepting new patients | |
| University Physician Group | Audiologist | Past | Accepting new patients |
Interoperability endpoints
- jlivernois12795@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.
-
- Audiologist
- Detroit, MI
- NPI 1699851618
-
dba Henry Ford Health System
- Children's Substance Abuse Rehabilitation Facility
- West Bloomfield, MI
- NPI 1295767630
-
dba Wayne State University Physician Group
- Audiologist
- Southfield, MI
- NPI 1346289600
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421193600000",
"number": "1316277114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3352 PADDINGTON DR",
"city": "TROY",
"state": "MI",
"postal_code": "480841241",
"telephone_number": "248-229-3508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2799 W GRAND BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482022608",
"telephone_number": "313-916-3280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIVERNOIS",
"first_name": "JEANNE",
"middle_name": "ANN",
"credential": "AU.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-12-30",
"last_updated": "2015-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "MI",
"license": "1601000152",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JEANNE",
"last_name": "FOWLER",
"middle_name": "ANN",
"credential": "AU.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.