Individual provider Active NPI

Jennifer Destefano, NP-C

  • Family Nurse Practitioner
  • Grosse Pointe, MI
National Provider Identifier
1720535552
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704282745 Issued in MI
Practice address
468 Cadieux Rd
Grosse Pointe, MI 48230-1507
Phone
(313) 473-1000
NPI assigned
Sep 9, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704282745 MI Primary

Addresses

Primary practice location

468 Cadieux Rd
Grosse Pointe, MI 48230-1507

Mailing address

2879 Roundtree Dr
Troy, MI 48083-2331
Phone (586) 604-0465

Other names 1

  • Jennifer Bezrutch Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jbezrutch16185@direct.beaumont.edu

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
I20161005002435 MI Practitioner - Nurse Practitioner 0042508194 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beaumont Medical Group- Specialty ServicesGroup PAC ID 7214299866, 868 clinicians

Practice addresses (Care Compare)

28100 Grand River Ave
Farmington Hills, MI 48336-5970

468 Cadieux Rd
Grosse Pointe, MI 48230-1507
Phone (313) 473-1705

Hospital & facility affiliations

  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089

Merit-based Incentive Payment System (MIPS)

Final score
84.37 of 100Reported as group
Quality
66.73
Promoting interoperability
100
Improvement activities
40
Cost
70.98

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704282745MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beaumont Medical Group Hospital -Based Services CurrentSince Jul 13, 2018 Accepting new patients
Beaumont Medical Group- Specialty Services CurrentSince Nov 15, 2022 Accepting new patients

Locations

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

468 Cadieux Rd
Grosse Pt Wds, MI 48230
Phone (313) 343-1000

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

Interoperability endpoints

  • Direct secure messaging: jdestefano1458869@epic00.shdirect.org

Organizations & group practices 2

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 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": "1473379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1720535552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2879 ROUNDTREE DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480832331",
            "telephone_number": "586-604-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "468 CADIEUX RD",
            "city": "GROSSE POINTE",
            "state": "MI",
            "postal_code": "482301507",
            "telephone_number": "313-473-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEFANO",
        "first_name": "JENNIFER",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-09",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704282745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbezrutch16185@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "468 Cadieux Rd",
            "city": "Grosse Pointe",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482301507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BEZRUTCH",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grosse Pointe, MI

Sources for this page

Verify at the official NPI Registry.