Individual provider Active NPI

Jessica V Misich-Jabiro, MD

  • Internal Medicine Physician
  • Grosse Pointe Woods, MI
National Provider Identifier
1578053765
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301504088 Issued in MI
Practice address
19251 Mack Ave Ste 333
Grosse Pointe Woods, MI 48236-2898
Phone
(313) 343-7774
NPI assigned
May 14, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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 4301504088 MI Primary
Student in an Organized Health Care Education/Training Program 390200000X 4301115012 MI

Addresses

Primary practice location

19251 Mack Ave Ste 333
Grosse Pointe Woods, MI 48236-2898

Mailing address

19251 Mack Ave Ste 333
Grosse Pointe Woods, MI 48236-2898
Phone (313) 343-7280

Other names 1

  • Jessica V Misich Former name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210511001001 MI Practitioner - Internal Medicine 4981969789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health St. John HospitalGroup PAC ID 3173424082, 332 clinicians

Practice addresses (Care Compare)

19251 Mack Ave
Suite 333
Grosse Pointe Woods, MI 48236-2898
Phone (313) 343-7280

Hospital & facility affiliations

  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301504088MIMDInternal Medicine Physician
4301115012MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Specialists of Southeast Michigan PC Current Accepting new patients
Henry Ford Health St. John Hospital CurrentSince May 11, 2021 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
Henry Ford Health St. John Hospital Internal Medicine CurrentSince May 11, 2021 Accepting new patients
St. John Hospital Past Accepting new patients

Locations

3187 Solutions Ctr
Chicago, IL 60677

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

22201 Moross Rd
Ste 50
Grosse Pointe Woods, MI 48236
Phone (313) 343-7774

19251 Mack Ave
Ste 333
Grosse Pointe Woods, MI 48236
Phone (313) 343-7280

Interoperability endpoints

  • Direct secure messaging: jmisich1141773@direct.hfhs.org

Organizations & group practices 5

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 2

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": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1578053765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19251 MACK AVE STE 333",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482362898",
            "telephone_number": "313-343-7280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19251 MACK AVE STE 333",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482362898",
            "telephone_number": "313-343-7774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISICH-JABIRO",
        "first_name": "JESSICA",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-14",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301504088",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301115012",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "MISICH",
            "middle_name": "V",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grosse Pointe Woods, MI

Sources for this page

Verify at the official NPI Registry.