Active NPI
Kyler Jackson
- Social Worker
- Ann Arbor, MI
National Provider Identifier
1386216703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6851114487
- Practice address
- 4788 Washtenaw Ave Apt B7
Ann Arbor, MI 48108-3113 - Phone
- (717) 808-7198
- NPI assigned
- Jul 14, 2021
- Last updated
- May 26, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.2101858-TRNE | OH | |
| Social Worker | 104100000X | 6851114487 | MI | Primary |
Addresses
Primary practice location
4788 Washtenaw Ave Apt B7
Ann Arbor, MI 48108-3113
Mailing address
415 Glensprings Dr Ste 201
Cincinnati, OH 45246-2353
Phone (513) 771-9600
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
343 River Oaks Dr
Milford, MI 48381-1037
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6851114487 | MI | MD | Social Worker |
| S.2101858-TRNE | OH | MD | Social Worker |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653523200000",
"number": "1386216703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 GLENSPRINGS DR STE 201",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452462353",
"telephone_number": "513-771-9600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4788 WASHTENAW AVE APT B7",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481083113",
"telephone_number": "717-808-7198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-14",
"last_updated": "2022-05-26",
"certification_date": "2022-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.2101858-TRNE",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6851114487",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; 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.