Individual provider Active NPI

Jaclyn Brothers, PA-C

  • Physician Assistant
  • Flint, MI
National Provider Identifier
1619397601
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4466 W Bristol Rd
Flint, MI 48507-3170
Phone
(810) 733-1200
Fax
(810) 733-0688
NPI assigned
Apr 17, 2014
Last updated
Oct 30, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

4466 W Bristol Rd
Flint, MI 48507-3170

Mailing address

4466 W Bristol Rd
Flint, MI 48507-3170
Phone (810) 733-1200

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140619001166 MI Practitioner - Physician Assistant 6507080264 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wayne State University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

17015 Silver Pkwy
Fenton, MI 48430-3425
Phone (810) 593-0023

4466 W Bristol Rd
Flint, MI 48507-3170
Phone (810) 733-1200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
68.79 of 100Reported as group
Quality
20.79
Promoting interoperability
94
Improvement activities
40
Cost
80.19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Orthopedic Associates P L C Physician Assistant CurrentSince Jul 12, 2023 Accepting new patients
Family Orthopedic Associates P L C CurrentSince Jul 12, 2023 Accepting new patients
Family Orthopedic Associates P L C Physician Assistant Past Accepting new patients
Amd Primary Care, PLLC PastSince Jul 21, 2015 Accepting new patients
First Choice Urgent Care PC PastSince Jul 23, 2026 Accepting new patients

Locations

17015 Silver Pkwy
Fenton, MI 48430
Phone (810) 593-0023

1 Hurley Plz
Flint, MI 48503
Phone (810) 257-9000

4466 W Bristol Rd
Flint, MI 48507
Phone (810) 733-1200

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1619397601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4466 W BRISTOL RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485073170",
            "telephone_number": "810-733-1200",
            "fax_number": "810-733-0688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4466 W BRISTOL RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485073170",
            "telephone_number": "810-733-1200",
            "fax_number": "810-733-0688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROTHERS",
        "first_name": "JACLYN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-17",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

Verify at the official NPI Registry.