Individual provider Active NPI

Jesse Stephen Andersen, MD

  • Emergency Medicine Physician
  • Coldwater, MI
National Provider Identifier
1407506413
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4301515312 Issued in MI
Practice address
274 E Chicago St
Coldwater, MI 49036-2041
Phone
(517) 279-5400
NPI assigned
Mar 24, 2022
Last updated
Jun 30, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4301515312 MI Primary
Emergency Medicine Physician 207P00000X 01100214A IN

Addresses

Primary practice location

274 E Chicago St
Coldwater, MI 49036-2041

Mailing address

36475 Five Mile Rd
Livonia, MI 48154-1971
Phone (734) 655-4800

Other practice location 1

36475 Five Mile Rd
Livonia, MI 48154-1971
Phone (734) 655-4800

Other practice location 2

2200 N Section St
Sullivan, IN 47882-7523
Phone (812) 268-4311

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260120003922 MI Practitioner - Emergency Medicine 1759762420 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Medical University of South Carolina College of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Emergency Care PCGroup PAC ID 3870493588, 21 clinicians

Practice addresses (Care Compare)

274 E Chicago St
Coldwater, MI 49036-2041
Phone (517) 279-5400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01100214AINMDEmergency Medicine Physician
4301515312MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Emergency Care, PC Emergency Medicine CurrentSince Dec 17, 2025 Accepting new patients

Locations

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2373

274 E Chicago St
Coldwater, MI 49036
Phone (517) 279-5400

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1407506413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36475 FIVE MILE RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481541971",
            "telephone_number": "734-655-4800",
            "fax_number": "734-655-2911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "274 E CHICAGO ST",
            "city": "COLDWATER",
            "state": "MI",
            "postal_code": "490362041",
            "telephone_number": "517-279-5400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36475 Five Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Livonia",
            "state": "MI",
            "postal_code": "481541971",
            "country_code": "US",
            "telephone_number": "734-655-4800",
            "fax_number": "734-655-2911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2200 N Section St",
            "address_purpose": "LOCATION",
            "city": "Sullivan",
            "state": "IN",
            "postal_code": "478827523",
            "country_code": "US",
            "telephone_number": "812-268-4311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "JESSE",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-24",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301515312",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01100214A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coldwater, MI

Sources for this page

Verify at the official NPI Registry.