NPIMap

Individual provider Active NPI

Jake Graehm Halvorsen, D.O.

  • Internal Medicine Physician
  • Warren, MI
National Provider Identifier
1497015002
Registry record updated May 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101019943 Issued in MI
Practice address
11885 E 12 Mile Rd
Ste. 300a
Warren, MI 48093-3474
Phone
(586) 582-6630
Fax
(586) 582-6631
NPI assigned
May 17, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 17, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101019943 MI Primary

Addresses

Primary practice location

11885 E 12 Mile Rd
Ste. 300a
Warren, MI 48093-3474

Mailing address

11885 E 12 Mile Rd
Ste. 300a
Warren, MI 48093-3474
Phone (586) 582-6630

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170505000190 CO Practitioner - Internal MedicinePractitioner - Emergency Medicine 9436456969 Reassigns benefits to 2 organizations
I20200324000105 TX Practitioner - Emergency Medicine 9436456969 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rocky Vista University College of Osteopathic Med, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7000 E Hampden Ave
Denver, CO 80224-3012
Phone (330) 925-4199

9949 S Oswego St
Parker, CO 80134-3753
Phone (303) 925-4700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.65 of 100Reported as group
Quality
86.65
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.85 of 100Reported as group
Quality
91.15
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.86 of 100Reported as group
Quality
92.78
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
75.55 of 100Reported as group
Quality
70.56
Improvement activities
40
Cost
72.48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101019943MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Usacs Community Emergency Services of Colorado, Inc. Current Accepting new patients
Usacs Integrated Acute Care Services of Texas, PLLC Internal Medicine CurrentSince Oct 28, 2021 Accepting new patients
Usacs of Colorado, Inc Current Accepting new patients
Third Coast Emergency Physicians Southwest PA CurrentSince Feb 25, 2020 Accepting new patients
Usacs Community Emergency Services of Colorado, Inc. CurrentSince Jan 1, 2018 Accepting new patients
Usacs Community Emergency Services of Colorado, Inc. CurrentSince Jan 1, 2018 Accepting new patients
Usacs of Colorado Inc CurrentSince Sep 30, 2024 Accepting new patients

Locations

16320 W 64th Ave
Arvada, CO 80007
Phone (303) 925-4560

7000 E Hampden Ave
Denver, CO 80224
Phone (330) 925-4199

7700 S Broadway
Littleton, CO 80122
Phone (303) 269-4786

3501 Mills Ave
Austin, TX 78731
Phone (512) 324-1017

260 Cully Dr
Kerrville, TX 78028
Phone (830) 258-7323

100 Medical Pkwy
Lakeway, TX 78738
Phone (512) 206-8100

4103 N Loop 1604 W
San Antonio, TX 78249
Phone (210) 572-8415

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.

Hospital & facility affiliations 10

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": "1337212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337212800000",
    "number": "1497015002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11885 E 12 MILE RD",
            "address_2": "STE. 300A",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933474",
            "telephone_number": "586-582-6630",
            "fax_number": "586-582-6631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11885 E 12 MILE RD",
            "address_2": "STE. 300A",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933474",
            "telephone_number": "586-582-6630",
            "fax_number": "586-582-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALVORSEN",
        "first_name": "JAKE",
        "middle_name": "GRAEHM",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-17",
        "last_updated": "2012-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101019943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.