Jerome Bekker, DO
Individual provider Active NPI Family Medicine Physician · Canton, MI
NPI 1336105014 · NPPES record last updated Feb 17, 2011
Key facts
- NPI
- 1336105014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- JB010278 (MI)
- Practice address
- 44633 Joy Rd Ste 100
Canton, MI 48187-1731 - Phone
- (734) 453-5360
- Fax
- (734) 453-5380
- NPI assigned
- Apr 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
44633 Joy Rd
Suite 100
Canton, MI 48187-1731
Phone (734) 453-5360
Hospital & facility affiliations
- Trinity Health Ann Arbor Hospital
- Corewell Health Wayne Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
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: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050502000351 | MI | Practitioner - Family Practice | 1456390897 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JB010278 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Plymouth Canton Family Health Care PC | Family Medicine | Current |
Accepting new patients |
| Oakwood Healthcare, Inc. | Past | Accepting new patients |
Locations
44633 Joy Rd
Ste 100
Canton, MI 48187
Phone (734) 453-5360
261 S Main St
Plymouth, MI 48170
Phone (734) 453-5360
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | JB010278 | MI | Yes |
Addresses
Primary practice location
44633 Joy Rd Ste 100
Canton, MI 48187-1731
Mailing address
PO Box 700890
Plymouth, MI 48170-0955
Phone (734) 453-5360
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 364570412 | Other | MI | TAX ID |
| 114731255 | Medicaid | MI |
Other providers in Canton, MI
- Tabithia Beavers
- John A Becker
- Madeline M Becker
- Saundra Beden
- Kathryn Petrowski Bedikian
- Allison Bell
- Melissa Bell
- Belleville-Canton Optometry LLC
- Bellies, Babies & Beyond
- Benchmark Physical Therapy Michigan LLC
All providers in Canton, MI · Family Medicine Physician 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 17, 2011. 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.