Individual provider Active NPI

Jacklyn L Quade, MD

  • Internal Medicine Physician
  • Canton, MI
National Provider Identifier
1790078624
Registry record updated Mar 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301098317 Issued in MI
Practice address
1051 N Canton Center Road
Canton, MI 48187-5097
Phone
(734) 844-5400
NPI assigned
May 25, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Internal Medicine) Physician 207RS0010X 4301098317 MI
Pediatrics Physician 208000000X 4301098317 MI
Internal Medicine Physician 207R00000X 4301098317 MI Primary

Addresses

Primary practice location

1051 N Canton Center Road
Canton, MI 48187-5097

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

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
I20160713001211 MI Practitioner - Internal Medicine 1355641218 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Maryland School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the University of MichiganGroup PAC ID 3779496856, shared by 45 NPIs, 3,344 clinicians

Practice addresses (Care Compare)

1051 N Canton CNTR Rd
University of Michigan Med Peds Association
Ann Arbor, MI 48187-5097
Phone (734) 844-5400

1051 N Canton Ctr
Canton, MI 48187-5097
Phone (734) 844-5390

1051 N Canton Ctr Rd
Canton, MI 48187-5097

1500 E Med CNTR Dr 3Rd FL B
University of Michigan Med Peds Association
Ann Arbor, MI 48109-0100
Phone (734) 936-5882

1500 E Medical CNTR Dr
Univeristy of Michigan Med Peds Association
Ann Arbor, MI 48109-0100
Phone (734) 936-4202

39901 Traditions Dr
Northville, MI 48168-9493

Hospital & facility affiliations

  • University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan CurrentSince Jun 30, 2016 Accepting new patients
Regents of the University of Michigan Sports Medicine CurrentSince Jun 30, 2016 Accepting new patients
Regents of the University of Michigan Internal Medicine CurrentSince Jun 30, 2016 Accepting new patients
Regents of the University of Michigan Current Accepting new patients

Locations

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

3621 S State St
#700
Ann Arbor, MI 48108

1051 N Canton Center Rd
Canton, MI 48187
Phone (734) 647-5670

Interoperability endpoints

  • Direct secure messaging: jquade26416@direct.med.umich.edu

Organizations & group practices 4

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": "1306281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583452800000",
    "number": "1790078624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 N CANTON CENTER ROAD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481875097",
            "telephone_number": "734-844-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUADE",
        "first_name": "JACKLYN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-25",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "MI",
            "license": "4301098317",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301098317",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301098317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

Verify at the official NPI Registry.