Individual provider Active NPI

Kati Jo Shearer

  • Adult Health Nurse Practitioner
  • Dearborn, MI
National Provider Identifier
1689051088
Registry record updated May 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
4704273834 Issued in MI
Practice address
19401 Hubbard Dr
Dearborn, MI 48126-2641
Phone
(313) 982-8100
NPI assigned
May 5, 2015
Last updated
May 5, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 4704273834 MI Primary

Addresses

Primary practice location

19401 Hubbard Dr
Dearborn, MI 48126-2641

Mailing address

35450 Kenton Ave
Brownstown, MI 48173-9627
Phone (734) 626-5886

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
I20150609000986 MI Practitioner - Nurse Practitioner 9234450776 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

19401 Hubbard Dr
Dearborn, MI 48126-2641
Phone (313) 982-8100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704273834MIMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Nurse Practitioner CurrentSince May 4, 2015 Accepting new patients
Henry Ford Health System CurrentSince May 4, 2015 Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients

Locations

19401 Hubbard Dr
Dearborn, MI 48126
Phone (313) 982-8100

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

Interoperability endpoints

  • Direct secure messaging: kshearer12269@direct.hfhs.org

Organizations & group practices 3

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": "1430784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430784000000",
    "number": "1689051088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35450 KENTON AVE",
            "city": "BROWNSTOWN",
            "state": "MI",
            "postal_code": "481739627",
            "telephone_number": "734-626-5886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19401 HUBBARD DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262641",
            "telephone_number": "313-982-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEARER",
        "first_name": "KATI",
        "middle_name": "JO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-05",
        "last_updated": "2015-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704273834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.