NPIMap

Individual provider Active NPI

Jaclyn Nicole Anderson, PA

  • Physician Assistant
  • Ypsilanti, MI
National Provider Identifier
1477950095
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007235 Issued in MI
Practice address
5333 McAuley Drive
Ypsilanti, MI 48197
Phone
(734) 712-3971
Fax
(734) 887-8941
NPI assigned
Nov 25, 2014
Last updated
Jan 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

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 5601007235 MI Primary

Addresses

Primary practice location

5333 McAuley Drive
Ypsilanti, MI 48197

Mailing address

24 Frank Lloyd Wright Drive
J2000
Ann Arbor, MI 48105
Phone (734) 747-6766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150417000136 MI Practitioner - Physician Assistant 7911225214 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

44428 Woodward Ave
Suite 102
Pontiac, MI 48341-5009
Phone (734) 712-8700

51341 W Huron River Dr
Trinity Health Iha Medical Group Primary Ca
Van Buren Township, MI 48111-2571
Phone (734) 997-0304

5301 E Huron River Dr
Ypsilanti, MI 48197-1051

5301 McAuley Dr
Ypsilanti, MI 48197-1051

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601007235MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Chelsea Community Hospital CurrentSince Aug 1, 2019 Accepting new patients
Saint Joseph Mercy Livingston Hospital CurrentSince Apr 17, 2017 Accepting new patients
St Joseph Mercy Hospital CurrentSince Feb 9, 2016 Accepting new patients
Sjmhs Anesthesia Services Current Accepting new patients
Saint Joseph Mercy Livingston Hospital CurrentSince Apr 17, 2017 Accepting new patients
Iha Health Services Corporation CurrentSince Feb 1, 2024 Accepting new patients
Hospitalist Physicians Medical Group of Michigan, PC CurrentSince Jun 19, 2018 Accepting new patients
Iha Health Service Corporation CurrentSince Feb 1, 2024 Accepting new patients
St Joseph Mercy Hospital CurrentSince Feb 9, 2016 Accepting new patients
Iha Health Services Corporation Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

1600 S Canton Center Rd
Canton, MI 48188
Phone (734) 398-7557

775 S Main St
Chelsea, MI 48118
Phone (313) 995-3764

620 Byron Rd
Howell, MI 48843
Phone (517) 545-5450

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

2333 Biddle Ave
Wyandotte, MI 48192
Phone (734) 246-6000

5333 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-5300

Interoperability endpoints

  • Direct secure messaging: janderson24836@direct.trinity-health.org

Organizations & group practices 15

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

View all 15

Hospital & facility affiliations 1

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": "1416873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704153600000",
    "number": "1477950095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DRIVE",
            "address_2": "J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48105",
            "telephone_number": "734-747-6766",
            "fax_number": "734-222-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5333 MCAULEY DRIVE",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "48197",
            "telephone_number": "734-712-3971",
            "fax_number": "734-887-8941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JACLYN",
        "middle_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-25",
        "last_updated": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.