Abby St. Jacques, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301098592 Issued in MI

Practice address

300 Meadow Run Dr
Hastings, MI 49058-9048

Phone

(269) 818-1020

NPI assigned

Jun 23, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Southside Pediatrics PC

  • Pediatrics Physician
  • Hastings, MI
  • NPI 1912252909
  NPD (past)

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

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406073600000",
    "number": "1487940946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MEADOW RUN DR",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490589048",
            "telephone_number": "269-818-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MEADOW RUN DR",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490589048",
            "telephone_number": "269-818-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST. JACQUES",
        "first_name": "ABBY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-23",
        "last_updated": "2014-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301098592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spectrum Health Primary Care Partners
• Spectrum Health Primary Care Partners
• Spencer P Barnes
• James Robert Spindler, M.D.
• Vickie J Sprague
• Andrea Stahl, OTL
• Carol Stayton
• Kendyll Lynn Stevens, PT, DPT
• Christopher Jordan Stewart
• Emily Stewart, MSW

• Pediatrics Physician in Hastings, MI
• Providers in Hastings, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.