Active NPI
Jonathon P State, M.D.
- Family Medicine Physician
- Birmingham, MI
National Provider Identifier
1376595066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301074553
- Practice address
- 757 Vinewood
Birmingham, MI 48009 - Phone
- (248) 644-6029
- Fax
- (519) 258-7896
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301074553 | MI | Primary |
Addresses
Primary practice location
757 Vinewood
Birmingham, MI 48009
Mailing address
757 Vinewood
Birmingham, MI 48009
Phone (248) 644-6029
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4301074553 | Other | MI | PHYSICIAN LICENSE |
| C7104 | Other | MI | MCARE |
| CC3713 | Other | MI | RR MEDICARE |
| 127456 | Other | MI | MERCY CARE CHOICES |
| 700H21076 | Other | MI | BCBSM |
| 1591463 | Other | MI | CIGNA |
| 1730121 | Other | MI | UHC |
| 4120366 | Medicaid | MI | |
| 5228630 | Other | MI | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301074553 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304640000000",
"number": "1376595066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "757 VINEWOOD",
"city": "BIRMINGHAM",
"state": "MI",
"postal_code": "48009",
"telephone_number": "248-644-6029",
"fax_number": "519-258-7896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "757 VINEWOOD",
"city": "BIRMINGHAM",
"state": "MI",
"postal_code": "48009",
"telephone_number": "248-644-6029",
"fax_number": "519-258-7896"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STATE",
"first_name": "JONATHON",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2011-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301074553",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIAN LICENSE",
"identifier": "4301074553",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCARE",
"identifier": "C7104",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "CC3713",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCY CARE CHOICES",
"identifier": "127456",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "700H21076",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1591463",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "1730121",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4120366",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5228630",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.