NPIMap

Individual provider Active NPI

Mark Double, D.O.

  • Anesthesiology Physician
  • Jackson, MI
National Provider Identifier
1669403903
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
51-01-011675 Issued in MI
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 788-4963
Fax
(517) 789-5903
NPI assigned
Jul 5, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 51-01-011675 MI Primary

Addresses

Primary practice location

205 N East Ave
Jackson, MI 49201-1753

Mailing address

205 N East Ave
Jackson, MI 49201-1753
Phone (517) 788-4963

Other identifiers 1

IdentifierTypeStateIssuer
4586940MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040405001180 MI Practitioner - Anesthesiology 1052304284 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Michigan State University College of Osteopathic Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Associates of Ann Arbor PLLCGroup PAC ID 1355317223, 213 clinicians

Practice addresses (Care Compare)

2006 Hogback Rd
Ann Arbor, MI 48105-9750

205 N E Ave
Jackson, MI 49201-1753

205 S E Ave
Henry Ford Allegiance Digestive Health
Jackson, MI 49201-2413
Phone (517) 205-2103

5300 Elliott Dr
Ypsilanti, MI 48197-8632
Phone (734) 434-6262

5301 E Huron River Dr
Ypsilanti, MI 48197-1051
Phone (734) 712-3456

5301 McAuley Dr
Ypsilanti, MI 48197-1051
Phone (734) 712-3456

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Huron Gastroenterology Associates PC Anesthesiology CurrentSince Jun 1, 2021 Accepting new patients
Center for Digestive Care LLC CurrentSince Dec 19, 2018 Accepting new patients
Huron Gastroenterology Associates PC CurrentSince Jun 1, 2021 Accepting new patients
W.a. Foote Memorial Hospital, Inc CurrentSince Sep 1, 2024 Accepting new patients
Anesthesia Associates of Ann Arbor, PLLC Anesthesiology CurrentSince Apr 1, 2010 Accepting new patients
W. a. Foote Memorial Hospital, Inc Current Accepting new patients
Wa Foote Memorial Hospital Inc CurrentSince Sep 1, 2024 Accepting new patients
Henry Ford Pathology Current Accepting new patients
Anesthesia Associates at Foote Hospital, PC Anesthesiology Past Accepting new patients
Morgan Medical Management, PC Anesthesiology Past Accepting new patients

Locations

2006 Hogback Rd
Ste 5
Ann Arbor, MI 48105
Phone (313) 712-4331

2006 Hogback Rd
Ste 5A
Ann Arbor, MI 48105
Phone (734) 786-2317

620 Byron Rd
Howell, MI 48843
Phone (517) 545-5450

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

5300 Elliott Dr
Ypsilanti, MI 48197
Phone (734) 434-6262

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: mdouble452141@direct.hfhs.org

Organizations & group practices 10

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669403903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-788-4963",
            "fax_number": "517-789-5903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-788-4963",
            "fax_number": "517-789-5903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUBLE",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "51-01-011675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4586940",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.