NPIMap

Individual provider Active NPI

Jerry A Dancik, MD

  • Nephrology Physician
  • Royal Oak, MI
National Provider Identifier
1366412066
Registry record updated Nov 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
4301033510 Issued in MI
Practice address
32121 Woodward Ave 200
Royal Oak, MI 48073-0999
Phone
(248) 690-9946
Fax
(248) 268-3661
NPI assigned
Jan 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 4301033510 MI Primary

Addresses

Primary practice location

32121 Woodward Ave 200
Royal Oak, MI 48073-0999

Mailing address

32121 Woodward Ave 200
Royal Oak, MI 48073-0999
Phone (248) 690-9946

Other identifiers 2

IdentifierTypeStateIssuer
4218461MedicaidMI
4095853MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040628000471 MI Practitioner - NephrologyPractitioner - Internal MedicinePractitioner - Interventional Radiology 0547156614 Reassigns benefits to 1 organization
Receives reassigned benefits from 3 practitioners
Practice locations: Lake Orion, MI; Royal Oak, MI; Sterling Heights, MI

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Wayne State University School of Medicine, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Access and Vascular CareGroup PAC ID 8628200987, 3 clinicians

Practice addresses (Care Compare)

10861 W 10 Mile Rd
Oak Park, MI 48237-1745
Phone (248) 268-1135

1455 S Lapeer Rd
Suite 207
Lake Orion, MI 48360-1468
Phone (248) 690-9946

Hospital & facility affiliations

  • Fresenius Kidney Care Beaumont Health - Sterling Heights Dialysis facility, Sterling Heights, MI, CCN 232733
  • Fresenius Kidney Care Rochester Hills Dialysis Dialysis facility, Rochester Hills, MI, CCN 232731
  • Fresenius Dialysis Services of Shelby Dialysis facility, Shelby Township, MI, CCN 232627
  • DaVita Troy Dialysis Dialysis facility, Sterling Heights, MI, CCN 232739
  • Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269
  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
  • Beaumont Hospital - Farmington Hills Hospital, Farmington Hills, MI, CCN 230151
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089
  • Beaumont Health Systems Inpatient rehabilitation facility, Troy, MI, CCN 23T269

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Access and Vascular Care Nephrology CurrentSince Aug 13, 2014 Accepting new patients
Jerry a Dancik Nephrology PastSince Aug 1, 2013 Accepting new patients

Locations

10861 W 10 Mile Rd
Oak Park, MI 48237
Phone (248) 268-1135

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447286400000",
    "number": "1366412066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32121 WOODWARD AVE 200",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480730999",
            "telephone_number": "248-690-9946",
            "fax_number": "248-268-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32121 WOODWARD AVE 200",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480730999",
            "telephone_number": "248-690-9946",
            "fax_number": "248-268-3661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANCIK",
        "first_name": "JERRY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2015-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "4301033510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4218461",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4095853",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.