NPIMap

Individual provider Active NPI

Maryconi M Jacob, MD

  • Gastroenterology Physician
  • Troy, MI
National Provider Identifier
1548558588
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
4301098130 Issued in MI
Practice address
264 W Maple Rd Ste 200
Troy, MI 48084
Phone
(248) 273-9930
NPI assigned
Jul 12, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301098130 MI
Gastroenterology Physician 207RG0100X 4301098130 MI Primary

Addresses

Primary practice location

264 W Maple Rd Ste 200
Troy, MI 48084

Mailing address

264 W Maple Rd Ste 200
Troy, MI 48084-5458
Phone (248) 273-9930

Other practice location 1

3601 W 13 Mile Rd Ste Ll
Royal Oak, MI 48073-6712
Phone (248) 551-3000

Other names 1

  • Maryconi Jaurigue Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mjaurigue47094@direct.beaumont.edu

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170914002021 MI Practitioner - Internal MedicinePractitioner - Gastroenterology 8426289711 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Gastroenterology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gastrointestinal Specialists PCGroup PAC ID 4880590264, 16 clinicians

Practice addresses (Care Compare)

264 W Maple Rd
Suite 200
Troy, MI 48084-5458
Phone (248) 273-9930

Hospital & facility affiliations

  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
  • Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269
  • Beaumont Hospital - Farmington Hills Hospital, Farmington Hills, MI, CCN 230151

Merit-based Incentive Payment System (MIPS)

Final score
96.26 of 100Reported as group
Quality
100
Promoting interoperability
100
Improvement activities
40
Cost
83.02

Merit-based Incentive Payment System (MIPS)

Final score
84.37 of 100Reported as group
Quality
66.73
Promoting interoperability
100
Improvement activities
40
Cost
70.98

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy52
Upper gastrointestinal (GI) endoscopy for acid reflux107

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Beaumont Medical Group- Specialty Services CurrentSince Jun 1, 2018 Accepting new patients
Gastrointestinal Specialists PC Gastroenterology CurrentSince Aug 1, 2017 Accepting new patients
Essential Anesthesia Services, PLC PastSince Mar 1, 2012 Accepting new patients

Locations

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

3535 W 13 Mile Rd
Ste Ll
Royal Oak, MI 48073
Phone (248) 551-3000

3601 W 13 Mile Rd
Ste Ll
Royal Oak, MI 48073
Phone (248) 551-3000

264 W Maple Rd
Ste 200
Troy, MI 48084
Phone (248) 273-9930

Interoperability endpoints

  • Direct secure messaging: mjaurigue47094@direct.beaumont.edu
  • Direct secure messaging: mjacob1239468@epic00.shdirect.org

Organizations & group practices 3

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.

Hospital & facility affiliations 11

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": "1310428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1548558588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 W MAPLE RD STE 200",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480845458",
            "telephone_number": "248-273-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 W MAPLE RD STE 200",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48084",
            "telephone_number": "248-273-9930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3601 W 13 Mile Rd Ste Ll",
            "address_purpose": "LOCATION",
            "city": "Royal Oak",
            "state": "MI",
            "postal_code": "480736712",
            "country_code": "US",
            "telephone_number": "248-551-3000",
            "fax_number": "248-551-4784",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "MARYCONI",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-12",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301098130",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "4301098130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mjaurigue47094@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3601 W 13 Mile Rd Ste Ll",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARYCONI",
            "last_name": "JAURIGUE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.