NPIMap

Individual provider Active NPI

Jonathan Paul Wulff, DO

  • Family Medicine Physician
  • Eaton Rapids, MI
National Provider Identifier
1417913104
Registry record updated Mar 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
JW006732 Issued in MI
Practice address
1501 Kyle Street
Eaton Rapids, MI 48827
Phone
(517) 663-4821
Fax
(517) 663-5650
NPI assigned
Apr 22, 2006
Last updated
Mar 9, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X JW006732 MI Primary

Addresses

Primary practice location

1501 Kyle Street
Eaton Rapids, MI 48827

Mailing address

PO Box 269
Eaton Rapids, MI 48827
Phone (517) 663-4821

Other identifiers 6

IdentifierTypeStateIssuer
P59044OtherMIBLUE CHOICE POS
791063605OtherMIRR MEDICARE
0100445OtherMIPHYSICIAN HEALTH PLAN
0152300115OtherMIBCBS
1388397MedicaidMI
4053314OtherMIAETNA

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
I20080620000666 MI Practitioner - Family Practice 6103713672

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1974
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1501 Kyle St
Eaton Rapids, MI 48827-8908

PO Box
Suite 269
Eaton Rapids, MI 48827-0269

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
JW006732MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jonathan P Wulff, D.O., PC Family Medicine CurrentSince Mar 1, 2008 Accepting new patients

Locations

1501 Kyle St
Eaton Rapids, MI 48827
Phone (517) 663-3344

Interoperability endpoints

  • Direct secure messaging: jonathanwulff@jpwdopc.allscriptsdirect.net

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 8

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": "1145664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457481600000",
    "number": "1417913104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 269",
            "city": "EATON RAPIDS",
            "state": "MI",
            "postal_code": "48827",
            "telephone_number": "517-663-4821",
            "fax_number": "517-663-5650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KYLE STREET",
            "city": "EATON RAPIDS",
            "state": "MI",
            "postal_code": "48827",
            "telephone_number": "517-663-4821",
            "fax_number": "517-663-5650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WULFF",
        "first_name": "JONATHAN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-22",
        "last_updated": "2016-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "JW006732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE POS",
            "identifier": "P59044",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "791063605",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN HEALTH PLAN",
            "identifier": "0100445",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0152300115",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1388397",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4053314",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eaton Rapids, MI

Sources for this page

Verify at the official NPI Registry.