Active NPI
Jerry Samuel Walden, M.D.
- Family Medicine Physician
- Ann Arbor, MI
National Provider Identifier
1427168913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- JW027573
- Practice address
- 3174 Packard St
Ann Arbor, MI 48108-1947 - Phone
- (734) 971-1073
- Fax
- (734) 971-8545
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
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 | JW027573 | MI | Primary |
Addresses
Primary practice location
3174 Packard St
Ann Arbor, MI 48108-1947
Mailing address
3174 Packard St
Ann Arbor, MI 48108-1947
Phone (734) 971-1073
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0817265 | Other | MI | BLUE CARE NETWORK |
| 103791 | Other | MI | CARE CHOICES |
| C-2855 | Other | MI | M-CARE |
| B45555 | Other | MI | HAP |
| 0808172651 | Other | MI | BCBS |
| 1639933 | Medicaid | MI |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JW027573 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1427168913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3174 PACKARD ST",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481081947",
"telephone_number": "734-971-1073",
"fax_number": "734-971-8545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3174 PACKARD ST",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481081947",
"telephone_number": "734-971-1073",
"fax_number": "734-971-8545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDEN",
"first_name": "JERRY",
"middle_name": "SAMUEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "JW027573",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "0817265",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE CHOICES",
"identifier": "103791",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "M-CARE",
"identifier": "C-2855",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAP",
"identifier": "B45555",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0808172651",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1639933",
"state": "MI"
}
],
"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 Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.