Thomas Jakubczak, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4704144957 Issued in MI

Practice address

3990 John R St
Detroit, MI 48201-2018

Phone

(952) 442-9770

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1990

Medicare assignment

May accept Medicare assignment

Group practices

Northstar Anesthesia of Michigan III PLLCGroup PAC ID 7911325469, 561 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Northstar Anesthesia of Michigan III PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Irving, TX
  • NPI 1972126209

  MI, Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Ambulatory Anesthesia Associates, PC

  • Anesthesiology Physician
  • Monroe, MI
  • NPI 1952350555

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Great Lakes Eye Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Saginaw, MI
  • NPI 1265542849
  Medicare reassignment NPD
• Northland Radiology Inc

  • Diagnostic Radiology Physician
  • Southfield, MI
  • NPI 1386804060
  Medicare reassignment NPD
• PSJ Anesthesia PC

  • Certified Registered Nurse Anesthetist
  • Southfield, MI
  • NPI 1275905796

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Northstar Anesthesia of Michigan PLLC

  • Anesthesiology Physician
  • Irving, TX
  • NPI 1871986372

  MI, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Northland Radiology Inc.

  • Physical Medicine & Rehabilitation Physician
  • Southfield, MI
  • NPI 1225652993
  NPD
• Great Lakes Eye Surgery LLC

  • Certified Registered Nurse Anesthetist
  • Saginaw, MI
  • NPI 1225725203

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477561629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67000",
            "address_2": "DEPT 203401",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482670002",
            "telephone_number": "952-442-9770",
            "fax_number": "952-442-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012018",
            "telephone_number": "952-442-9770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAKUBCZAK",
        "first_name": "THOMAS",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704144957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MI",
            "identifier": "TJ144957",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104300794",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suraj Jaipalli, MD
• Jaja Discount Pharmacy PLLC
• Katherine Jaje, MD
• Krishna Jakkula, NP-C
• Anna Jakovichtchouk
• Krista Marie Jakubik, DPT
• Lejla Jakupovic, PHARMD
• Jalah'S Home Help Care LLC
• Jalazar Industries LLC
• Abdul Rub Jaleel

• Certified Registered Nurse Anesthetist in Detroit, MI
• Providers in Detroit, MI by specialty
• Certified Registered Nurse Anesthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.