Individual provider Active NPI

Jerry Uzansky, D.O.

  • Family Medicine Physician
  • Detroit, MI
National Provider Identifier
1477523892
Registry record updated Oct 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
GU005238 Issued in MI
Practice address
4771 Michigan Ave
Detroit, MI 48210-3247
Phone
(313) 897-2600
Fax
(313) 897-2424
NPI assigned
Jan 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2007

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 GU005238 MI Primary

Addresses

Primary practice location

4771 Michigan Ave
Detroit, MI 48210-3247

Mailing address

4771 Michigan Ave
Detroit, MI 48210-3247
Phone (313) 897-2600

Other identifiers 6

IdentifierTypeStateIssuer
P01030002OtherMIMEDICARE INDIVIDUAL #S
1117993MedicaidMI
0258220204OtherMIBCBS NUMBER
0P01030OtherMIMEDICARE GROUP NUMBER
1477523892OtherMINPI INDIVIDUAL
1285813154OtherMINPI GROUP NUMBER

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)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
GU005238MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sciometrix Inc CurrentSince Jan 15, 2023 Accepting new patients

Locations

306 S Washington Ave
Ste 600
Royal Oak, MI 48067

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193616000000",
    "number": "1477523892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4771 MICHIGAN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482103247",
            "telephone_number": "313-897-2600",
            "fax_number": "313-897-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4771 MICHIGAN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482103247",
            "telephone_number": "313-897-2600",
            "fax_number": "313-897-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UZANSKY",
        "first_name": "JERRY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2007-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "GU005238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL #S",
            "identifier": "P01030002",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1117993",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "0258220204",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "0P01030",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1477523892",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI GROUP NUMBER",
            "identifier": "1285813154",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.

Verify at the official NPI Registry.