Jon M Lake, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301068180 Issued in MI

Practice address

400 Hinckley Blvd
Suite 100
Jackson, MI 49203-6125

Phone

(517) 784-0588

Fax

(517) 784-3866

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jlake454393@direct.hfhs.org

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.

• Henry Ford Pathology

  • Anatomic Pathology & Clinical Pathology Physician
  • Detroit, MI
  • NPI 1851410005
  NPD
• Cogent Healthcare of Michigan PC

  • Internal Medicine Physician
  • Jackson, MI
  • NPI 1295047165

  Family Medicine

  NPD (past)
• Southerncare, Inc.

  • Community Based Hospice Care Agency
  • Chadds Ford, PA
  • NPI 1275232795

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1376561696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67000",
            "address_2": "DEPARTMENT 272801",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482670002",
            "telephone_number": "517-784-0588",
            "fax_number": "517-784-3866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HINCKLEY BLVD",
            "address_2": "SUITE 100",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492036125",
            "telephone_number": "517-784-0588",
            "fax_number": "517-784-3866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "JON",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301068180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00420975",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "80169124",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5187092-10",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlake454393@direct.hfhs.org",
            "affiliation": "Y",
            "affiliationName": "Henry Ford Health System",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2799 W Grand Blvd",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482022608",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlake454393@direct.hfhs.org",
            "affiliation": "Y",
            "affiliationName": "Henry Ford Health System",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2799 W Grand Blvd",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482022608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Patricia J Lafave, PHD
• Dawn Laforest, NP
• Dawn Marie Lafountain, MS
• Nicholas Lee Lagow, D.D.S.
• Rebecca Jo Laipply, MA
• Michelle Lake, LPC
• Jeevak Lal, M.D.
• Stephen Gary Lalka, M.D.
• De'Shone Cantrell Lamb
• Patricia L Lamb, MD

• Family Medicine Physician in Jackson, MI
• Providers in Jackson, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.