Individual provider Active NPI

Suzanne M Jacques, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Detroit, MI
National Provider Identifier
1326086497
Registry record updated Oct 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
4301052798 Issued in MI
Practice address
3990 John R St
Harper Hospital Pathology
Detroit, MI 48201-2018
Phone
(313) 745-8555
Fax
(313) 745-9299
NPI assigned
Jun 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 4301052798 MI Primary

Addresses

Primary practice location

3990 John R St
Harper Hospital Pathology
Detroit, MI 48201-2018

Mailing address

1560 E Maple Rd
Suite 400-Credentialing
Troy, MI 48083-1138
Phone (313) 745-8555

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
I20061228000030 MI Practitioner - Pathology 7810997749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Indiana University School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

1 Wiliam Carls Dr
Commerce Township, MI 48382-2201

3980 John R St
Detroit, MI 48201-2018
Phone (313) 745-8040

3990 John R St
Detroit, MI 48201-2018

4100 John R St
Detroit, MI 48201-2013
Phone (800) 527-6266

4201 Saint Antoine St
Detroit, MI 48201-2153

6071 W Outer Dr
Detroit, MI 48235-2624

Hospital & facility affiliations

  • Detroit Receiving Hospital Hospital, Detroit, MI, CCN 230273
  • Harper University Hospital Hospital, Detroit, MI, CCN 230104
  • Karmanos Cancer Center Hospital, Detroit, MI, CCN 230297

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301052798MIMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physician Group Anatomic Pathology & Clinical Pathology CurrentSince Oct 1, 2006 Accepting new patients
University Physician Group CurrentSince Oct 1, 2006 Accepting new patients

Locations

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

3990 John R St
Detroit, MI 48201
Phone (313) 745-6211

1560 E Maple Rd
Ste 400
Troy, MI 48083

1560 E Maple Rd
Ste 200
Troy, MI 48083
Phone (248) 581-5200

Interoperability endpoints

  • Direct secure messaging: sjacques@direct.dmc.org

Organizations & group practices 2

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477353600000",
    "number": "1326086497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E MAPLE RD",
            "address_2": "SUITE 400-CREDENTIALING",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831138",
            "telephone_number": "313-745-8555",
            "fax_number": "313-966-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 JOHN R ST",
            "address_2": "HARPER HOSPITAL PATHOLOGY",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012018",
            "telephone_number": "313-745-8555",
            "fax_number": "313-745-9299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "SUZANNE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2016-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "4301052798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.