Individual provider Active NPI

Miraflor Reyes-Ganzon, MD

  • Pediatrics Physician
  • Jackson, MI
National Provider Identifier
1457357055
Registry record updated Jun 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301068653 Issued in MI
Practice address
505 N Jackson St
Jackson, MI 49201-1266
Phone
(517) 748-5500
Fax
(517) 780-9286
NPI assigned
Jun 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301068653 MI Primary

Addresses

Primary practice location

505 N Jackson St
Jackson, MI 49201-1266

Mailing address

505 N Jackson St
Jackson, MI 49201-1266
Phone (517) 748-5500

Other identifiers 1

IdentifierTypeStateIssuer
3266277-10MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mreyesganzon445271@direct.hfhs.org Henry Ford Health System

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
I20080626000060 MI Practitioner - Pediatric Medicine 6204908890 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
New York Medical College, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Center for Family HealthGroup PAC ID 4587574421, 39 clinicians

Practice addresses (Care Compare)

505 N Jackson St
Jackson, MI 49201-1266

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301068653MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Family Health Pediatrics CurrentSince Dec 28, 2016 Accepting new patients
Center for Family Health Pediatrics CurrentSince Dec 28, 2016 Accepting new patients

Locations

2400 4th St
Jackson, MI 49203
Phone (517) 788-6812

300 S Blackstone St
Jackson, MI 49201
Phone (517) 539-8620

1024 Fleming Ave
Jackson, MI 49202
Phone (517) 748-5500

6700 Rives Junction Rd
Jackson, MI 49201
Phone (517) 569-3200

500 N Jackson St
Jackson, MI 49201
Phone (517) 748-5444

505 N Jackson St
Jackson, MI 49201
Phone (517) 748-5500

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749686400000",
    "number": "1457357055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 N JACKSON ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011266",
            "telephone_number": "517-748-5500",
            "fax_number": "517-780-9286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 N JACKSON ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011266",
            "telephone_number": "517-748-5500",
            "fax_number": "517-780-9286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYES-GANZON",
        "first_name": "MIRAFLOR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-28",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301068653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3266277-10",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mreyesganzon445271@direct.hfhs.org",
            "affiliation": "Y",
            "affiliationName": "Henry Ford Health System",
            "address_1": "2799 W Grand Blvd",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482022608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.