Caramarie Jackson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601004514 Issued in MI

Practice address

4620 Genesys Pkwy
Grand Blanc, MI 48439-8067

Phone

(810) 606-7200

Fax

(810) 606-7115

NPI assigned

Oct 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Caramarie C Brock Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: caramarie.jackson.1@30652.direct.athenahealth.com

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.

• Advanced Pain Management of Caro PC

  • Pain Medicine Physician
  • Caro, MI
  • NPI 1780454587
  Medicare reassignment
• Michigan Neurosurgical Institute, P.C

  • Neurological Surgery Physician
  • Grand Blanc, MI
  • NPI 1336184571
  Medicare reassignment
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1518047133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2559 STANMOOR DR",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483292365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398067",
            "telephone_number": "810-606-7200",
            "fax_number": "810-606-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CARAMARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601004514",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601004514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARAMARIE",
            "last_name": "BROCK",
            "middle_name": "C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tamara Roumayah Ivers, MD
• J Martin Ulrich DO PC
• Matthew Jaboro
• Jackson Chiropractic Clinic, PC
• Avery Michael Jackson III, M.D.
• Charles Arthur Jackson Jr., D.C.
• Evelyn Jackson, CRNA
• Givaunni S Jackson
• Erica Jacob, CCC-SLP
• Logan Thomas Jacobs, DO

• Medical Physician Assistant in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.