NPIMap

Organization Active NPI

Independent Emergency Physicians P.C.

  • Physician Assistant
  • Jackson, MI
National Provider Identifier
1700136520
Registry record updated Sep 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1784233 Issued in MI
Legal business name
INDEPENDENT EMERGENCY PHYSICIANS P.C.
Practice address
205 North East Avenue
Emergency Department
Jackson, MI 49201
Phone
(517) 788-4800
NPI assigned
Sep 19, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2012

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

Authorized official

Name
Julie Susin, MBA
Title
Business Manager
Phone
(248) 892-0715

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X 1784233 MI Primary

Addresses

Primary practice location

205 North East Avenue
Emergency Department
Jackson, MI 49201

Mailing address

PO Box 100
Royal Oak, MI 48068-0100
Phone (248) 849-3137

National Provider Directory

National Provider Directory
Tax ID family
Independent Emergency P2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348012800000",
    "number": "1700136520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480680100",
            "telephone_number": "248-849-3137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 NORTH EAST AVENUE",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49201",
            "telephone_number": "517-788-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT EMERGENCY PHYSICIANS P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-19",
        "last_updated": "2012-09-19",
        "status": "A",
        "authorized_official_last_name": "SUSIN",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "248-892-0715",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "1784233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.