NPIMap

Organization Active NPI

Jackson Orthopedics Specialist

  • Specialist
  • Jackson, MI
National Provider Identifier
1730397134
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
4301084403 Issued in MI
Legal business name
JACKSON ORTHOPEDICS SPECIALIST
Practice address
1100 E Michigan Ave
Suite 308
Jackson, MI 49201-1847
Phone
(517) 787-3900
Fax
(517) 787-4318
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Cheri Brautigam
Title
Office Manager
Phone
(517) 780-9257

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X 4301084403 MI Primary

Addresses

Primary practice location

1100 E Michigan Ave
Suite 308
Jackson, MI 49201-1847

Mailing address

1100 E Michigan Ave
Suite 308
Jackson, MI 49201-1847
Phone (517) 787-3900

Other identifiers 1

IdentifierTypeStateIssuer
4670042MedicaidMI

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730397134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E MICHIGAN AVE",
            "address_2": "SUITE 308",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011847",
            "telephone_number": "517-787-3900",
            "fax_number": "517-787-4318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E MICHIGAN AVE",
            "address_2": "SUITE 308",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011847",
            "telephone_number": "517-787-3900",
            "fax_number": "517-787-4318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON ORTHOPEDICS SPECIALIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRAUTIGAM",
        "authorized_official_first_name": "CHERI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "517-780-9257"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301084403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4670042",
            "state": "MI"
        }
    ],
    "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 Aug 22, 2020; 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.