Jacqueline Elizabeth Smith, AGPCNP-BC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

4704236096 Issued in MI

Practice address

29877 Telegraph Rd
Suite 401
Southfield, MI 48034-1332

Phone

(248) 651-8344

NPI assigned

Jul 23, 2015

Last updated

Sep 25, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Wook Kim MD PCGroup PAC ID 9830221514, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Wook Kim MD PC

  dba Farmbrook Interventional Pain and EMG

  • Specialist
  • Southfield, MI
  • NPI 1134459969
  Medicare reassignment Care Compare group NPD
• J Amarrah Medical Care Systems

  • General Practice Physician
  • Farmington Hills, MI
  • NPI 1750111381
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  MI, Nurse Practitioner

  Medicare reassignment NPD

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

{
    "created_epoch": "1437609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1538544218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29877 TELEGRAPH RD",
            "address_2": "SUITE 401",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341332",
            "telephone_number": "248-651-8344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29877 TELEGRAPH RD",
            "address_2": "SUITE 401",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341332",
            "telephone_number": "248-651-8344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACQUELINE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-23",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "4704236096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Smith
• Gareisha Smith
• Isabella Smith
• Isaiah R Smith
• Jackson Smith, DPT
• Jalisa Smith
• James Bernard Smith Jr., M.D., PH.D.
• Jasma Smith
• Johnny L Smith, M.S.
• Juan Smith

• Primary Care Nurse Practitioner in Southfield, MI
• Providers in Southfield, MI by specialty
• Primary Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; 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.

Verify at the official NPI Registry.