Individual provider Active NPI

Jasper Mukwada, FNP

  • Family Nurse Practitioner
  • Kalamazoo, MI
National Provider Identifier
1558815787
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71008591A Issued in IN
Practice address
601 John St
Box 74
Kalamazoo, MI 49007-5341
Phone
(269) 341-8481
Fax
(269) 341-7781
NPI assigned
Aug 4, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704274083 MI
Family Nurse Practitioner 363LF0000X 71008591A IN Primary

Addresses

Primary practice location

601 John St
Box 74
Kalamazoo, MI 49007-5341

Mailing address

601 John St
Box 74
Kalamazoo, MI 49007-5341
Phone (269) 341-8481

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20161007001484 MI Practitioner - Nurse Practitioner 4981992856 Reassigns benefits to 3 organizations
I20190109002136 IN Practitioner - Nurse Practitioner 4981992856 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71008591AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Radiant Star LLC Current Accepting new patients
Bronson Lakeview Hospital CurrentSince Sep 6, 2016 Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince Oct 9, 2023 Accepting new patients
Bronson Lakeview Hospital CurrentSince Sep 6, 2016 Accepting new patients
JD Cares LLC Current Accepting new patients
Bronson Methodist Hospital CurrentSince Sep 6, 2016 Accepting new patients
Zimshine LLC Current Accepting new patients
Aims, LLC CurrentSince Dec 14, 2018 Accepting new patients

Locations

417 S Whitlock St
Bremen, IN 46506
Phone (574) 546-0330

9330 Broadway
Crown Point, IN 46307
Phone (219) 648-2400

1625 E Jefferson Blvd
Mishawaka, IN 46545
Phone (219) 257-2295

601 John St
#74
Kalamazoo, MI 49007
Phone (269) 341-8481

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

451 Health Pkwy
Paw Paw, MI 49079
Phone (269) 655-1725

13 N Washington St
Ypsilanti, MI 48197
Phone (734) 329-4620

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Interoperability endpoints

  • Direct secure messaging: jasper.mukwada.1@28492.direct.athenahealth.com

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1470268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1558815787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "BOX 74",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-341-8481",
            "fax_number": "269-341-7781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "BOX 74",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-341-8481",
            "fax_number": "269-341-7781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUKWADA",
        "first_name": "JASPER",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-04",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704274083",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71008591A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.