Individual provider Active NPI

Jay Edgar Dujon, M.D.

  • Surgery Physician
  • Traverse City, MI
National Provider Identifier
1578734158
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301086439 Issued in MI
Practice address
1221 Sixth St Ste 300
Traverse City, MI 49684-2360
Phone
(231) 935-2400
Fax
(231) 935-2424
NPI assigned
Mar 21, 2008
Last updated
May 10, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 206790 LA
Surgery Physician 208600000X 4301086439 MI Primary

Addresses

Primary practice location

1221 Sixth St Ste 300
Traverse City, MI 49684-2360

Mailing address

1221 Sixth St Ste 300
Traverse City, MI 49684-2360
Phone (231) 935-2400

Other practice location 1

1501 Kings Hwy
Shreveport, LA 71103-4228
Phone (318) 675-5000

Other identifiers 2

IdentifierTypeStateIssuer
2356461MedicaidLA
348363YH54OtherLAMEDICARE - PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140612001719 LA Practitioner - General SurgeryPractitioner - Critical Care (Intensivists) 0749456242 Reassigns benefits to 1 organization
I20180725000234 MI Practitioner - General SurgeryPractitioner - Critical Care (Intensivists) 0749456242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Critical Care (Intensivists)
Education
University of Texas Medical Branch at Galveston, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians

Practice addresses (Care Compare)

701 W Front St
Suite 200
Traverse City, MI 49684-2287
Phone (231) 346-4000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
206790LAMDSurgery Physician
4301086439MIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lsu Health Sciences Center Shreveport Faculty Group Practice Surgery CurrentSince Dec 1, 2016 Accepting new patients
Munson Medical Center Current Accepting new patients
Munson Medical Center CurrentSince Aug 1, 2018 Accepting new patients
Munson Medical Center CurrentSince Aug 1, 2018 Accepting new patients
Munson Medical Center Past Accepting new patients
Munson Medical Center Past Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

1501 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0434

1512 W Kirby Pl
Shreveport, LA 71103
Phone (318) 626-0177

1541 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0287

1606 Kings Hwy
Shreveport, LA 71103
Phone (318) 675-6402

400 Hobart St
Cadillac, MI 49601
Phone (231) 876-7200

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

1221 Sixth St
Ste 300
Traverse City, MI 49684
Phone (231) 392-0640

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

4100 Park Forest Dr
Traverse City, MI 49684
Phone (231) 392-8900

701 W Front St
Ste 200
Traverse City, MI 49684
Phone (231) 346-4000

Organizations & group practices 6

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.

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": "1206057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1578734158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 SIXTH ST STE 300",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842360",
            "telephone_number": "231-935-2400",
            "fax_number": "231-935-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 SIXTH ST STE 300",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842360",
            "telephone_number": "231-935-2400",
            "fax_number": "231-935-2424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Kings Hwy",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711034228",
            "country_code": "US",
            "telephone_number": "318-675-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUJON",
        "first_name": "JAY",
        "middle_name": "EDGAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-21",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "206790",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301086439",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2356461",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - PTAN",
            "identifier": "348363YH54",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.