Individual provider Active NPI

Jacqueline Kirouac, MSN, AGNP-C, APRN

  • Primary Care Nurse Practitioner
  • Southfield, MI
National Provider Identifier
1689438574
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
AG11210087 Issued in MI
Practice address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone
(248) 849-3000
NPI assigned
Feb 12, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered Nurse 163WM0705X 4704341154 MI
Primary Care Nurse Practitioner 363LP2300X AG11210087 MI Primary

Addresses

Primary practice location

16001 W 9 Mile Rd
Southfield, MI 48075-4818

Mailing address

1848 Carsons CV
Commerce Township, MI 48390-1865
Phone (248) 881-4287

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
I20241003001537 MI Practitioner - Nurse Practitioner 5496286247 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
David Schwartzenfeld Medical PCGroup PAC ID 6406933795, 3 clinicians

Practice addresses (Care Compare)

633 S Blvd E
Suite 1200
Rochester Hills, MI 48307-5364
Phone (248) 705-6223

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AG11210087MIMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
David Schwartzenfeld Medical PC CurrentSince Aug 15, 2024 Accepting new patients

Locations

6825 Allen Rd
Allen Park, MI 48101

633 South Blvd E
Ste 1200
Rochester Hills, MI 48307
Phone (248) 705-6223

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1689438574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 CARSONS CV",
            "city": "COMMERCE TOWNSHIP",
            "state": "MI",
            "postal_code": "483901865",
            "telephone_number": "248-881-4287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16001 W 9 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "248-849-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIROUAC",
        "first_name": "JACQUELINE",
        "credential": "MSN, AGNP-C, APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "MI",
            "license": "4704341154",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "AG11210087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.