NPIMap

Organization Active NPI

Jagannathan Neurosurgical Institute PLLC

  • Neurological Surgery Physician
  • Troy, MI
National Provider Identifier
1356680912
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC
Practice address
3290 W Big Beaver Rd
Suite 150
Troy, MI 48084-2903
Phone
(248) 792-6527
Fax
(248) 792-9106
NPI assigned
Feb 1, 2013
Last updated
Jul 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Authorized official

Name
Dr. Jayant Jagannathan, M.D.NPI 1558578708
Title
President
Phone
(248) 792-6527

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X

Addresses

Primary practice location

3290 W Big Beaver Rd
Suite 150
Troy, MI 48084-2903

Mailing address

3290 W Big Beaver Rd
Suite 150
Troy, MI 48084-2903
Phone (248) 792-6527

Other identifiers 2

IdentifierTypeStateIssuer
1447299797MedicaidMI
P52980058MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130607000398 MI Part B Supplier - Clinic/Group Practice 9638317373 Receives reassigned benefits from 12 practitioners
Practice locations: Bay City, MI; Mt Pleasant, MI; Sault Sainte Marie, MI; Troy, MI; West Branch, MI
O20151009000453 MI DME Supplier - Physician - Neurosurgery 9638317373 Practice locations: Troy, MI

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

4 Columbus Ave
Ste 140
Bay City, MI 48708
Phone (989) 377-4550

4 Columbus Ave
Ste 260
Bay City, MI 48708
Phone (989) 308-1840

6245 Inkster Rd
Ste 206
Garden City, MI 48135

2333 Progress St
Fl 2
West Branch, MI 48661

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1359676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690502400000",
    "number": "1356680912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3290 W BIG BEAVER RD",
            "address_2": "SUITE 150",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480842903",
            "telephone_number": "248-792-6527",
            "fax_number": "248-792-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3290 W BIG BEAVER RD",
            "address_2": "SUITE 150",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480842903",
            "telephone_number": "248-792-6527",
            "fax_number": "248-792-9106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-01",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A",
        "authorized_official_last_name": "JAGANNATHAN",
        "authorized_official_first_name": "JAYANT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-792-6527",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447299797",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P52980058",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

  • 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.