Pediatric Center of Jackson

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

SS068721 Issued in MI

Legal business name

PEDIATRIC CENTER OF JACKSON

Practice address

1418 E Michigan Ave
Jackson, MI 49202-3518

Phone

(517) 783-1779

Fax

(517) 783-1899

NPI assigned

Oct 21, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Souha S Hakim, M.D.NPI 1699798249

Title

Owner

Phone

(517) 783-1779

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Souha S Hakim, M.D.

  • Pediatrics Physician
  • Jackson, MI
  • NPI 1699798249
  NPD Authorized official
• Emily Mattea, DNP

  • Pediatric Nurse Practitioner
  • Jackson, MI
  • NPI 1528846698
  NPD (past)

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224547200000",
    "number": "1659523876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1418 E MICHIGAN AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492023518",
            "telephone_number": "517-783-1779",
            "fax_number": "517-783-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 E MICHIGAN AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492023518",
            "telephone_number": "517-783-1779",
            "fax_number": "517-783-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CENTER OF JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "last_updated": "2008-10-21",
        "status": "A",
        "authorized_official_last_name": "HAKIM",
        "authorized_official_first_name": "SOUHA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-783-1779",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "SS068721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104499710",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edwin Payne, LPC
• Kylie Payne
• Salina Payne
• Pdhcrc, Inc.
• Pearle Vision Inc
• Pediatric Dentistry and Orthodontics of Jackson
• Brent Peek
• Dirk Peeters, PA-C
• Randoplh Penn, D.C.
• Shannon Penn, PHARMD

• Pediatrics Physician in Jackson, MI
• Providers in Jackson, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.