Active NPI
Jordan Conklin, PA-C
- Physician Assistant
- Jackson, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601009183
- Practice address
- 205 N East Ave
Jackson, MI 49201-1753 - Phone
- (517) 205-4800
- NPI assigned
- May 23, 2019
- Sex
- Female
- 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 | 5601009183 | MI | Primary |
Addresses
Primary practice location
205 N East Ave
Jackson, MI 49201-1753
Mailing address
259 Mack Ave
Detroit, MI 48201-2427
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jgebhar1@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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Wayne State University School of Medicine, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1277 Mercy Dr
Muskegon, MI 49444-4605
Phone 23167261862
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601009183 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wa Foote Memorial Hospital, Inc | Current | Accepting new patients | |
| W.a. Foote Memorial Hospital, Inc | Physician Assistant | Current | Accepting new patients |
Locations
205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730
7845 Spring Arbor Rd
Spring Arbor, MI 49283
Phone (517) 205-2580
Interoperability endpoints
- jconklin969426@direct.trinity-health.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.
-
dba Trinity Health Medical Group
- Internal Medicine Physician
- Muskegon, MI
- NPI 1124042700
-
dba Henry Ford Allegiance Health
- Nurse Practitioner
- Jackson, MI
- NPI 1629000708
-
dba Henry Ford Allegiance Health
- Physician Assistant
- Jackson, MI
- NPI 1538606348
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Mercy Health Muskegon
- General Acute Care Hospital
- Muskegon, MI
- NPI 1831132133
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588204800000",
"number": "1316504483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "259 MACK AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012427"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 N EAST AVE",
"city": "JACKSON",
"state": "MI",
"postal_code": "492011753",
"telephone_number": "517-205-4800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLIN",
"first_name": "JORDAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-23",
"last_updated": "2020-04-30",
"certification_date": "2020-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601009183",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jgebhar1@hfhs.org",
"affiliation": "N",
"address_1": "205 N East Ave",
"city": "Jackson",
"state": "MI",
"country_code": "US",
"postal_code": "492011753",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.