Individual provider Active NPI

Jacqueline Susan Metz, D.O

  • Pediatrics Physician
  • Dearborn, MI
National Provider Identifier
1316359854
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
5101021108 Issued in MI
Practice address
5500 Auto Club Dr
Dearborn, MI 48126-2779
Phone
(313) 425-4700
Fax
(313) 425-4701
NPI assigned
Jun 2, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 5101021108 MI
Pediatrics Physician 208000000X 5101021108 MI Primary

Addresses

Primary practice location

5500 Auto Club Dr
Dearborn, MI 48126-2779

Mailing address

5500 Auto Club Dr
Dearborn, MI 48126-2779
Phone (313) 425-4700

Other names 1

  • Jacqueline Susan Larouere Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmetz218088@direct.hfhs.org

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200504001843 MI Practitioner - Pediatric Medicine 6204267461 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101021108MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Pediatrics CurrentSince Apr 30, 2020 Accepting new patients
Henry Ford Health System CurrentSince Apr 30, 2020 Accepting new patients
Henry Ford Health System Current Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients

Locations

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

9100 Brombach St
Hamtramck, MI 48212
Phone (313) 972-9000

Interoperability endpoints

  • Direct secure messaging: jacquelinemetz@southfield.allscriptsdirect.net
  • Direct secure messaging: jmetz218088@direct.hfhs.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1316359854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 AUTO CLUB DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262779",
            "telephone_number": "313-425-4700",
            "fax_number": "313-425-4701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 AUTO CLUB DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262779",
            "telephone_number": "313-425-4700",
            "fax_number": "313-425-4701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "METZ",
        "first_name": "JACQUELINE",
        "middle_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-02",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "5101021108",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101021108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmetz218088@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "5500 Auto Club Dr",
            "city": "Dearborn",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481262779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "LAROUERE",
            "middle_name": "SUSAN",
            "credential": "D.O",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.