Individual provider Active NPI

Jonathon Faber, D.O.

  • Family Medicine Physician
  • Novi, MI
National Provider Identifier
1700048915
Registry record updated Sep 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101017744 Issued in MI
Practice address
42350 Grand River Ave
Novi, MI 48375-1838
Phone
(248) 697-2942
Fax
(248) 436-6628
NPI assigned
Jun 29, 2008
Last updated
Sep 9, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101017744 MI Primary
Sports Medicine (Family Medicine) Physician 207QS0010X 5101017744 MI
Sports Medicine (Family Medicine) Physician 207QS0010X 34.010276 OH

Addresses

Primary practice location

42350 Grand River Ave
Novi, MI 48375-1838

Mailing address

42350 Grand River Ave
Novi, MI 48375-1838
Phone (248) 697-2942

Other identifiers 1

IdentifierTypeStateIssuer
0054412MedicaidOH

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170120001463 MI Practitioner - Sports Medicine 0345412565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports Medicine
Education
Michigan State University College of Osteopathic Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Therapy Centers, IncGroup PAC ID 5092605717, 140 clinicians
Restorative Physical Medicine PLLCGroup PAC ID 0042631194, 20 clinicians

Practice addresses (Care Compare)

33010 Northwestern Hwy
West Bloomfield, MI 48322-3634

42350 Grand River Ave
Novi, MI 48375-1838
Phone (248) 697-2942

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.73 of 100Reported as group
Quality
78.82
Improvement activities
40
Cost
73.51

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101017744MIMDSports Medicine (Family Medicine) Physician
34.010276OHMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medcentral Professional Association Inc. PastSince Aug 13, 2012 Accepting new patients

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 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": "1214697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1700048915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42350 GRAND RIVER AVE",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483751838",
            "telephone_number": "248-697-2942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42350 GRAND RIVER AVE",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483751838",
            "telephone_number": "248-697-2942",
            "fax_number": "248-436-6628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FABER",
        "first_name": "JONATHON",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-29",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101017744",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MI",
            "license": "5101017744",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "OH",
            "license": "34.010276",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0054412",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Novi, MI

Sources for this page

Verify at the official NPI Registry.