Individual provider Active NPI

Carol Lynn Piesik, PA

  • Physician Assistant
  • Jackson, MI
National Provider Identifier
1457306987
Registry record updated Mar 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601003005 Issued in MI
Practice address
110 N Elm Ave
Jackson, MI 49202-3571
Phone
(517) 788-6760
Fax
(517) 788-3029
NPI assigned
May 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601003005 MI Primary

Addresses

Primary practice location

110 N Elm Ave
Jackson, MI 49202-3571

Mailing address

Department 272801
PO Box 67000
Detroit, MI 48267-2728
Phone (517) 841-6913

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040520000554 MI Practitioner - Physician Assistant 0749271500 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstreet Urgent Care of MichiganGroup PAC ID 6305188491, 129 clinicians

Practice addresses (Care Compare)

16525 Fort St
Southgate, MI 48195-1403
Phone (734) 250-9529

2078 E Big Beaver Rd
Beaumont Urgent Care of Michigan
Troy, MI 48083-2301
Phone (248) 918-0744

23100 Michigan Ave
Dearborn, MI 48124-2033
Phone (313) 263-7584

29263 Orchard Lake Rd
Farmington Hills, MI 48334-2953
Phone (248) 488-5900

6200 Middlebelt Rd
Garden City, MI 48135-2409
Phone (734) 367-9100

6549 N Canton Ctr Rd
Beaumont Urgent Care of Michigan
Canton, MI 48187-1653
Phone (734) 589-1969

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
76.04 of 100Reported as group
Quality
67.93
Promoting interoperability
100
Improvement activities
40
Cost
52.21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lansing Urgent Care, PLC Past Accepting new patients
Center for Hematology-Oncology of S. Michigan Past Accepting new patients
Medical Observation Services, PLLC Past Accepting new patients
Wellstreet Urgent Care of Michigan PastSince Aug 6, 2023 Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205452800000",
    "number": "1457306987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT 272801",
            "address_2": "PO BOX 67000",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482672728",
            "telephone_number": "517-841-6913",
            "fax_number": "517-841-6917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N ELM AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492023571",
            "telephone_number": "517-788-6760",
            "fax_number": "517-788-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIESIK",
        "first_name": "CAROL",
        "middle_name": "LYNN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.