NPIMap

Individual provider Active NPI

Jacob Ryan Lynn, P.A.

  • Physician Assistant
  • Royal Oak, MI
National Provider Identifier
1659422384
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601010017 Issued in MI
Practice address
3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone
(248) 898-0123
Fax
(248) 898-1473
NPI assigned
Jan 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X TPA0012 MS
Medical Physician Assistant 363AM0700X
Surgical Physician Assistant 363AS0400X PA60030903 WA
Surgical Physician Assistant 363AS0400X PA.200096 LA
Physician Assistant 363A00000X 5601010017 MI Primary

Addresses

Primary practice location

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

Mailing address

26901 Beaumont Blvd # 3D
Southfield, MI 48033-3849
Phone (947) 522-1952

Other practice location 1

314 Martin Luther King Jr Way
Tacoma, WA 98405-4250
Phone (253) 403-7257

Other practice location 2

44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-8432

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jlynn1863625@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090116000014 WA Practitioner - Physician Assistant 5597869495 Reassigns benefits to 2 organizations
I20210122001419 MI Practitioner - Physician Assistant 5597869495 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beaumont Medical Group Hospital Based ServicesGroup PAC ID 3072875889, 575 clinicians

Practice addresses (Care Compare)

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

3601 W 13 Mile Rd Ec
Beaumont Emergency Services Ro
Royal Oak, MI 48073-6712
Phone (248) 898-0575

44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-1187

44201 Dequindre Rd Ec
Beaumont Emergency Services TR
Troy, MI 48085-1117
Phone (248) 964-5111

Hospital & facility affiliations

  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.200096LAMDSurgical Physician Assistant
TPA0012MSMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Saginaw CurrentSince Sep 1, 2024 Accepting new patients
Multicare Health System CurrentSince Sep 1, 2008 Accepting new patients
Mymichigan Medical Center Saginaw CurrentSince Sep 1, 2024 Accepting new patients
Mymichigan Medical Center Saginaw Past Accepting new patients
Mymichigan Medical Center Saginaw Past Accepting new patients

Locations

1117 S Van Dyke Rd
Ste 300
Bad Axe, MI 48413

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

3570 Shattuck Rd
Saginaw, MI 48603
Phone (989) 792-5353

1015 S Washington Ave
Saginaw, MI 48601
Phone (989) 754-3289

Interoperability endpoints

  • Direct secure messaging: jlynn1244465@epic00.shdirect.org
  • Direct secure messaging: jacob.lynn.1@11016.direct.athenahealth.com
  • Direct secure messaging: jlynnpac21752@direct.multicare.org

Organizations & group practices 12

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 3

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": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1659422384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD # 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1952",
            "fax_number": "947-522-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-898-0123",
            "fax_number": "248-898-1473"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "314 Martin Luther King Jr Way",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984054250",
            "country_code": "US",
            "telephone_number": "253-403-7257",
            "fax_number": "253-403-1340",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "44201 Dequindre Rd",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MI",
            "postal_code": "480851117",
            "country_code": "US",
            "telephone_number": "248-964-8432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LYNN",
        "first_name": "JACOB",
        "middle_name": "RYAN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MS",
            "license": "TPA0012",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60030903",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "PA.200096",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlynn1863625@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3601 W 13 Mile Rd",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.