Active NPI
Brandon Berka
- Student in an Organized Health Care Education/Training Program
- Jackson, MI
National Provider Identifier
1497379945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 4351046921
- Practice address
- 205 N East Ave
Jackson, MI 49201-1753 - Phone
- (517) 205-4800
- NPI assigned
- Jun 1, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 4351046921 | MI | Primary |
Addresses
Primary practice location
205 N East Ave
Jackson, MI 49201-1753
Mailing address
205 N East Ave
Jackson, MI 49201-1753
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200622002814 | MI | Order and Referring Only - Emergency Medicine | 4688096530 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4351046921 | MI | MD | Student in an Organized Health Care Education/Training Program |
Interoperability endpoints
- bberka528730@direct.hfhs.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686268800000",
"number": "1497379945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 N EAST AVE",
"city": "JACKSON",
"state": "MI",
"postal_code": "492011753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 N EAST AVE",
"city": "JACKSON",
"state": "MI",
"postal_code": "492011753",
"telephone_number": "517-205-4800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERKA",
"first_name": "BRANDON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-01",
"last_updated": "2023-06-09",
"certification_date": "2023-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": "4351046921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; 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.