Northwest Neurology PC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

4301058568 Issued in MI

Legal business name

NORTHWEST NEUROLOGY PC

Doing business as

Northwest Neurology and Neurodiagnostic Center

Practice address

27200 Lahser Rd
Suite 100
Southfield, MI 48034-2137

Phone

(248) 208-9215

Fax

(248) 208-9217

NPI assigned

Mar 19, 2007

Last updated

Oct 18, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tessy C Jenkins, MDNPI 1548269897

Title

President

Phone

(248) 208-9215

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• NORTHWEST NEUROLOGY AND NEURODIAGNOSTIC CENTER Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tessy C Jenkins, M.D.

  • Neurology Physician
  • Southfield, MI
  • NPI 1548269897
  Medicare reassignment NPD Authorized official
• Marianne Dolores McKissick, PAC

  • Physician Assistant
  • Marysville, MI
  • NPI 1710154521
  Medicare reassignment

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287360000000",
    "number": "1467576132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27200 LAHSER RD",
            "address_2": "SUITE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480342137",
            "telephone_number": "248-208-9215",
            "fax_number": "248-208-9217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27200 LAHSER RD",
            "address_2": "SUITE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480342137",
            "telephone_number": "248-208-9215",
            "fax_number": "248-208-9217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST NEUROLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2010-10-18",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "TESSY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-208-9215",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301058568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4639614",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHWEST NEUROLOGY AND NEURODIAGNOSTIC CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Northwest Dermatolgy Group, PC
• Northwest Detroit Dialysis Center LLC
• Northwest Detroit Dialysis Center LLC
• Northwest Eye Physicians, P.C.
• Northwest Home Health Services Inc (Metro Home Care)
• Northwest Ophthalmology,PC
• Northwest Surgical Associates PC
• Northwestern Psychiatry & Counseling Center PC
• Northwestern Rehabilitation Services LLC
• Northwestern Rehabilitation Services. LLC

• Neurology Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• Neurology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.