Jennifer Christine Maxam Fenner, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

JG013790 Issued in MI

Practice address

419 W. Wackerly St
Midland, MI 48640

Phone

(989) 631-9515

Fax

(989) 835-6824

NPI assigned

Mar 17, 2006

Last updated

Jul 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Family Medicine Associates of Midland, P.C.

  • Pediatrics Physician
  • Midland, MI
  • NPI 1033188735
  Medicare reassignment NPD
• Family Medicine Associates of Midland, P.C.

  • Family Medicine Physician
  • Coleman, MI
  • NPI 1619946373
  NPD

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1679542922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 W. WACKERLY ST",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "48640",
            "telephone_number": "989-631-9515",
            "fax_number": "989-835-6824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 W. WACKERLY ST",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "48640",
            "telephone_number": "989-631-9515",
            "fax_number": "989-835-6824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXAM FENNER",
        "first_name": "JENNIFER",
        "middle_name": "CHRISTINE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "JG013790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4287010",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen J Mattichak, MD
• Brehanna Elaine Matzke
• Kayla Matzke
• Brian Mauch, MD
• Graceson Caroline Maxa
• Cilisa Maxson
• Maxwell Hogue DDS PLC
• Megan Maxwell, NCHW-C
• Melissa Kathryn Maxwell, LMSW
• Whitney Rae Maxwell, PA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.