Active NPI
Emily Lynn Jackson, PA-C
- Physician Assistant
- Warren, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601009550
- Practice address
- 30736 Hoover Rd
Warren, MI 48093-2555 - Phone
- (734) 927-5225
- NPI assigned
- Oct 22, 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 | 5601009550 | MI | Primary |
Addresses
Primary practice location
30736 Hoover Rd
Warren, MI 48093-2555
Mailing address
9151 Butwell St
Livonia, MI 48150-3439
Phone (734) 233-7722
Other practice location 1
1498 S Sheldon Rd
Plymouth, MI 48170-2140
Phone (734) 927-5335
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
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1111 W 9 Mile Rd
Ferndale, MI 48220-1219
Phone (248) 246-0141
1602 W Michigan Ave
Jackson, MI 49202-4003
Phone (248) 536-2127
27204 Beck Rd
Novi, MI 48374-1348
Phone (248) 513-3719
8273 Grand River Rd
Suite 140
Brighton, MI 48114-9346
Phone (810) 588-6610
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601009550 | MI | MD | Physician Assistant |
Interoperability endpoints
- ejackson951056@direct.hfhs.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 and National Provider Directory roles.
-
- Urgent Care Clinic/Center
- Jackson, MI
- NPI 1336725688
-
dba Healthy Urgent Care
- Urgent Care Clinic/Center
- New Hudson, MI
- NPI 1124266754
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571702400000",
"number": "1346883493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9151 BUTWELL ST",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481503439",
"telephone_number": "734-233-7722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30736 HOOVER RD",
"city": "WARREN",
"state": "MI",
"postal_code": "480932555",
"telephone_number": "734-927-5225"
}
],
"practiceLocations": [
{
"address_1": "1498 S Sheldon Rd",
"address_purpose": "LOCATION",
"city": "Plymouth",
"state": "MI",
"postal_code": "481702140",
"country_code": "US",
"telephone_number": "734-927-5335",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "EMILY",
"middle_name": "LYNN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-22",
"last_updated": "2019-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601009550",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; 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.