Individual provider Active NPI

Mark A. Jonker, M.D.

  • Surgery Physician
  • Brighton, MI
National Provider Identifier
1780620039
Registry record updated Dec 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301108483 Issued in MI
Practice address
2305 Genoa Business Park Dr Ste 120
Brighton, MI 48114
Phone
(810) 494-6881
Fax
(810) 494-6882
NPI assigned
Jun 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 258991 MA
Surgery Physician 208600000X 4301108483 MI Primary

Addresses

Primary practice location

2305 Genoa Business Park Dr Ste 120
Brighton, MI 48114

Mailing address

24 Frank Lloyd Wright Dr Lbby J2000
Ann Arbor, MI 48105-9484

Other practice location 1

55 Lake Ave N
Department of Surgery
Worcester, MA 01655-0002
Phone (508) 334-0545

Other practice location 2

55 Lake Ave N
Department of Surgery
Worcester, MA 01655-0002
Phone (508) 334-0545

Other identifiers 1

IdentifierTypeStateIssuer
110099977AMedicaidMA

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
I20151008000568 MI Practitioner - General Surgery 1355587080 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Medical College of Wisconsin, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

2305 Genoa Bus Park Dr
Brighton, MI 48114-7005

2305 Genoa Bus PK Dr
Brighton, MI 48114-7004

44428 Woodward Ave
Suite 102
Pontiac, MI 48341-5009
Phone (734) 712-8700

51341 W Huron River Dr
Trinity Health Iha Medical Group Primary Ca
Van Buren Township, MI 48111-2571
Phone (734) 997-0304

5301 E Huron River Dr
Ypsilanti, MI 48197-1051

5301 McAuley Dr
Ypsilanti, MI 48197-1051

620 Byron Rd
Howell, MI 48843-1002

7575 Grand River Rd
Brighton, MI 48114-9309
Phone (734) 712-7255

7575 Grand River Rd
Brighton, MI 48114-9390

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301108483MIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary Mercy Physician Practices CurrentSince Oct 1, 2015 Accepting new patients
Iha Health Services Corporation Surgery CurrentSince Nov 1, 2018 Accepting new patients
Iha Health Service Corporation CurrentSince Nov 1, 2018 Accepting new patients
St Mary Mercy Physician Practices CurrentSince Oct 1, 2015 Accepting new patients
Iha Health Services Corporation Current Accepting new patients
Saint Joseph Mercy Livingston Hospital Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

2305 Genoa Business Park Dr
Ste 120
Brighton, MI 48114
Phone (810) 494-6881

49650 Cherry Hill Rd
Ste 120
Canton, MI 48187
Phone (734) 398-7800

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

620 Byron Rd
Ste 1200
Howell, MI 48843
Phone (517) 545-6011

14555 Levan Rd
Ste 112
Livonia, MI 48154
Phone (734) 712-1000

19000 St Joes Pkwy
Ste 310
Livonia, MI 48152
Phone (248) 743-4490

36475 5 Mile Rd
Livonia, MI 48154
Phone (734) 464-4800

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

Interoperability endpoints

  • Direct secure messaging: mjonker44605@direct.trinity-health.org

Organizations & group practices 6

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544054400000",
    "number": "1780620039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR LBBY J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 GENOA BUSINESS PARK DR STE 120",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "48114",
            "telephone_number": "810-494-6881",
            "fax_number": "810-494-6882"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Lake Ave N",
            "address_2": "Department of Surgery",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "508-334-0545",
            "fax_number": "774-443-0544",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 Lake Ave N",
            "address_2": "Department of Surgery",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "508-334-0545",
            "fax_number": "774-443-0544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JONKER",
        "first_name": "MARK",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2018-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "258991",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301108483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110099977A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brighton, MI

Sources for this page

Verify at the official NPI Registry.