Individual provider Active NPI

Jennifer Lynn Zizzo, NP

  • Nurse Practitioner
  • Niles, MI
National Provider Identifier
1780675140
Registry record updated Jul 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704258909 Issued in MI
Practice address
42 N Saint Joseph Ave
Suite 201
Niles, MI 49120-2203
Phone
(269) 687-0808
Fax
(269) 687-0811
NPI assigned
Nov 3, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 129854 WI
Nurse Practitioner 363L00000X 4704258909 MI Primary

Addresses

Primary practice location

42 N Saint Joseph Ave
Suite 201
Niles, MI 49120-2203

Mailing address

42 N Saint Joseph Ave
Suite 201
Niles, MI 49120-2203
Phone (269) 687-0808

Other identifiers 1

IdentifierTypeStateIssuer
1780675140MedicaidMI

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
I20080603000413 MI Practitioner - Nurse Practitioner 3375613383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

42 N Saint Joseph Ave
Suite 201
Niles, MI 49120-2203
Phone (269) 687-0808

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
129854WIMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Medical Practices CurrentSince Jun 1, 2010 Accepting new patients
Lakeland Medical Practices CurrentSince Jun 1, 2010 Accepting new patients

Locations

6416 Deans Hill Rd
Berrien Ctr, MI 49102
Phone (269) 471-7741

261 M 62
Cassopolis, MI 49031
Phone (269) 445-3874

42 N Saint Joseph Ave
Ste 201
Niles, MI 49120
Phone (269) 429-5007

31 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 428-2417

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

Interoperability endpoints

  • Direct secure messaging: jzizzo2993@lakeland.midirect.net
  • Direct secure messaging: jzizzo1272880@epic00.corewelldirect.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 1

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": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405468800000",
    "number": "1780675140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 N SAINT JOSEPH AVE",
            "address_2": "SUITE 201",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202203",
            "telephone_number": "269-687-0808",
            "fax_number": "269-687-0811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 N SAINT JOSEPH AVE",
            "address_2": "SUITE 201",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202203",
            "telephone_number": "269-687-0808",
            "fax_number": "269-687-0811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIZZO",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-03",
        "last_updated": "2014-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "WI",
            "license": "129854",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704258909",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780675140",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, MI

Sources for this page

Verify at the official NPI Registry.