Jijan John, MD
Individual provider Active NPI Family Medicine Physician · Newport, MI
NPI 1487819652 · NPPES record last updated Apr 17, 2025
Key facts
- NPI
- 1487819652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4301094978 (MI)
- Practice address
- 7825 N Dixie Hwy # 101
Newport, MI 48166-9750 - Phone
- (734) 240-4580
- NPI assigned
- Jul 27, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Promedica Monroe Physicians
Practice addresses (Care Compare)
3175 Smith Rd
Lambertville, MI 48144-9434
Phone (734) 856-5494
Hospital & facility affiliations
- Promedica Monroe Regional Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250325000549 | MI | Practitioner - Family Practice | 5193246155 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301094978 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Promedica Monroe Physicians | Family Medicine | Current |
Accepting new patients |
Locations
3175 Smith Rd
Lambertville, MI 48144
Phone (734) 856-5494
14930 Laplaisance Rd
Ste 118
Monroe, MI 48161
Phone (734) 240-2892
7825 N Dixie Hwy
Ste 101
Newport, MI 48166
7825 N Dixie Hwy
#101
Newport, MI 48166
Phone (734) 240-4580
Interoperability endpoints
- jjohn338911@direct.promedica.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 4301094978 | MI | Yes |
Addresses
Primary practice location
7825 N Dixie Hwy # 101
Newport, MI 48166-9750
Mailing address
7825 N Dixie Hwy # 101
Newport, MI 48166-9750
Phone (734) 240-4580
Other providers in Newport, MI
- Human Services Solutions LLC
- Tina M Hurst
- Kyle Michael Imes
- Deborah Lee Jagotka
- Amber Jenkins
- Batul-Bita Khatibshahidi
- Tabatha Lawson
- Taylor Liparoto
- Elizabeth Magyar
- Anna Miller
All providers in Newport, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.