Individual provider Active NPI

Jason John Baker, AGANCP-BC, CCRN, RN

  • Acute Care Nurse Practitioner
  • Southfield, MI
National Provider Identifier
1487217931
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
4704272464 Issued in MI
Practice address
18000 W 9 Mile Rd Ste 525
Southfield, MI 48075-4080
Phone
(248) 327-6196
NPI assigned
Apr 19, 2019
Last updated
Jan 23, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 4704272464 MI Primary

Addresses

Primary practice location

18000 W 9 Mile Rd Ste 525
Southfield, MI 48075-4080

Mailing address

1674 Leblanc St
Lincoln Park, MI 48146-3912
Phone (313) 402-9257

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200316000770 MI Practitioner - Nurse Practitioner 8921436478 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
4704272464MIMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vitality Visiting Physicians, PLLC CurrentSince Oct 24, 2022 Accepting new patients
And J Management Company LLC CurrentSince Dec 21, 2021 Accepting new patients
Traveling Physician Services PC Nurse Practitioner CurrentSince Jun 2, 2025 Accepting new patients
Advance Homecare Systems CurrentSince Aug 1, 2024 Accepting new patients
MVP Diagnostic Laboratory LLC PastSince Feb 15, 2021 Accepting new patients
Integrated Physician Solutions PC PastSince Feb 1, 2020 Accepting new patients

Locations

16250 Northland Dr
Ste 318
Southfield, MI 48075
Phone (248) 862-5311

18000 W 9 Mile Rd
Ste 525
Southfield, MI 48075
Phone (248) 327-6195

24901 Northwestern Hwy
Ste 303
Southfield, MI 48075
Phone (248) 728-4169

4007 Carpenter Rd
Ypsilanti, MI 48197
Phone (586) 419-3007

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1487217931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1674 LEBLANC ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481463912",
            "telephone_number": "313-402-9257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18000 W 9 MILE RD STE 525",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754080",
            "telephone_number": "248-327-6196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "JASON",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "AGANCP-BC, CCRN, RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-19",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704272464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.