Active NPI
Jack Edison Cribb, D.O.
- Internal Medicine Physician
- Charlotte, MI
National Provider Identifier
1497961635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 1769156
- Practice address
- 3618 Benton Rd
Charlotte, MI 48813-7756 - Phone
- (517) 652-1059
- NPI assigned
- May 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 1769156 | MI | Primary |
Addresses
Primary practice location
3618 Benton Rd
Charlotte, MI 48813-7756
Mailing address
3618 Benton Rd
Charlotte, MI 48813-7756
Phone (517) 652-1059
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 |
|---|---|---|---|---|
| I20090119000074 | MI | Practitioner - Internal Medicine | 2961565965 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Michigan State University College of Osteopathic Medicine, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
109 Michigan St NW
Suite 200
Grand Rapids, MI 49503-2302
Phone (616) 330-2522
134 S Cochran Ave
Charlotte, MI 48813-1557
Phone (517) 541-1000
Hospital & facility affiliations
- Elara Caring
- University of Michigan Health - Sparrow Eaton
- Edward W Sparrow Hospital
- Eaton Rapids Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1769156 | MI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adult Internal Medicine and Family Care, PLC | Internal Medicine | Current | Accepting new patients |
| Bamf Health I PC | Current | Accepting new patients | |
| Family Medical Associates | Past | Accepting new patients | |
| Sparrow Eaton Hospital | Past | Accepting new patients |
Locations
134 S Cochran Ave
Ste B
Charlotte, MI 48813
Phone (517) 541-1000
109 Michigan St NW
Ste 200
Grand Rapids, MI 49503
Phone (616) 330-2522
Interoperability endpoints
- jack.cribb.1@27453.direct.athenahealth.com
- https://api.platform.athenahealth.com/5296/brand/1/csg/1/fhir/r4
Organizations & group practices 4
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.
-
- Internal Medicine Physician
- Charlotte, MI
- NPI 1174759989
Internal Medicine, MI
-
- General Practice Physician
- Charlotte, MI
- NPI 1205871548
-
- School Nurse Practitioner
- East Lansing, MI
- NPI 1063227486
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Lansing, MI
- NPI 1073588711
Hospital
-
- General Acute Care Hospital
- Lansing, MI
- NPI 1760710719
Hospital
-
- Home Health Agency
- Jackson, MI
- NPI 1588642110
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497961635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3618 BENTON RD",
"city": "CHARLOTTE",
"state": "MI",
"postal_code": "488137756",
"telephone_number": "517-652-1059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3618 BENTON RD",
"city": "CHARLOTTE",
"state": "MI",
"postal_code": "488137756",
"telephone_number": "517-652-1059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRIBB",
"first_name": "JACK",
"middle_name": "EDISON",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "1769156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.