Michigan Neurosurgical Institute, P.C

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

AJ076974 Issued in MI

Legal business name

MICHIGAN NEUROSURGICAL INSTITUTE, P.C

Practice address

9400 S Saginaw Rd Ste a
Grand Blanc, MI 48439-9666

Phone

(810) 606-7200

Fax

(810) 606-7115

NPI assigned

Jun 19, 2006

Last updated

Jul 28, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Avery Michael Jackson III, M.D.NPI 1851329197

Title

President

Phone

(810) 606-7200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Avery Michael Jackson III, M.D.

  • Neurological Surgery Physician
  • Grand Blanc, MI
  • NPI 1851329197
  Medicare reassignment NPD Authorized official
• Stefanija P Galovska, PA

  • Physician Assistant
  • Pontiac, MI
  • NPI 1649603663
  Medicare reassignment
• Caramarie Jackson, PA-C

  • Medical Physician Assistant
  • Grand Blanc, MI
  • NPI 1518047133
  Medicare reassignment

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690502400000",
    "number": "1336184571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9400 S SAGINAW RD STE A",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484399666",
            "telephone_number": "810-606-7200",
            "fax_number": "810-606-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 S SAGINAW RD STE A",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484399666",
            "telephone_number": "810-606-7200",
            "fax_number": "810-606-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN NEUROSURGICAL INSTITUTE, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "AVERY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-606-7200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MI",
            "license": "AJ076974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michigan Dental Wellness Center PLLC
• Michigan Independent Physicians Association, PLC (Michigan IPA)
• Michigan Lung and Critical Care Specialists, PC
• Michigan Maternal Fetal Medicine PLC
• Michigan Neurosurgical Institute PC
• Michigan Rheumatology Group PC
• Mid Michigan Center for Sleep Disorders Inc
• Mid Michigan Imaging Services LLC
• Mid-Michigan Hospitalist Group PC
• Mid-Michigan Specialty Clinics PLLC

• Neurological Surgery Physician in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• Neurological Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; 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.

Verify at the official NPI Registry.