Individual provider Active NPI

Jessica Marie Fisher, NP

  • Nurse Practitioner
  • Warren, MI
National Provider Identifier
1710540950
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704302723 Issued in MI
Practice address
11885 E 12 Mile Rd
Warren, MI 48093-3474
Phone
(586) 576-1615
NPI assigned
Apr 14, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704302723 MI Primary

Addresses

Primary practice location

11885 E 12 Mile Rd
Warren, MI 48093-3474

Mailing address

45567 Shoal Dr
Macomb, MI 48044-4239

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
I20191125000931 MI Practitioner - Nurse Practitioner 1951733344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health St. John HospitalGroup PAC ID 3173424082, 332 clinicians

Practice addresses (Care Compare)

11885 E 12 Mile Rd
100A Sjhmc Great Lakes Cancert Management S
Warren, MI 48093-3465
Phone (586) 576-1615

Hospital & facility affiliations

  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • Henry Ford Health Warren Hospital Hospital, Warren, MI, CCN 230195

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital CurrentSince Dec 1, 2019 Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Dec 1, 2019 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

4014 S River Rd
Ste 1
East China, MI 48054
Phone (810) 326-1229

19229 Mack Ave
Ste 24
Grosse Pointe Woods, MI 48236
Phone (313) 884-5522

19229 Mack Ave
Ste 34
Grosse Pointe Woods, MI 48236
Phone (313) 647-3245

17900 23 Mile Rd
Ste 402
Macomb, MI 48044
Phone (586) 868-9090

1901 Star Batt Dr
Ste 100C
Rochester Hills, MI 48309
Phone (248) 844-4000

44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255

11800 E 12 Mile Rd
Warren, MI 48093
Phone (586) 573-5000

11885 E 12 Mile Rd
Warren, MI 48093
Phone (586) 576-1615

11885 E 12 Mile Rd
Ste 100A
Warren, MI 48093
Phone (586) 576-1615

Interoperability endpoints

  • Direct secure messaging: jfisher1126811@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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1555200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580774400000",
    "number": "1710540950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45567 SHOAL DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480444239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11885 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933474",
            "telephone_number": "586-576-1615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-14",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704302723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.