Jennifer L Klock, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101015640 Issued in MI

Practice address

1510 S State Rd
Ste D
Davison, MI 48423-1965

Phone

(810) 652-3600

Fax

(810) 652-3603

NPI assigned

May 31, 2006

Last updated

Apr 12, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jenniferklock@pmi.allscriptsdirect.net
• Direct secure messaging: jklock1134883@direct.hfhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Genesys Pho LLC

  • Case Management Agency
  • Burton, MI
  • NPI 1275820110
  Medicare reassignment NPD
• Henry Ford Medical Group Genesys

  • Family Medicine Physician
  • Burton, MI
  • NPI 1598248718
  Medicare reassignment NPD
• Henry Ford Medical Group Genesys

  dba Ascension Genesys Ambulatory Therapy

  • Physical Therapist
  • Burton, MI
  • NPI 1114495793
  NPD

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460419200000",
    "number": "1801833975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 S CENTER RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485191455",
            "telephone_number": "810-424-2011",
            "fax_number": "810-249-4037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S STATE RD",
            "address_2": "STE D",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484231965",
            "telephone_number": "810-652-3600",
            "fax_number": "810-652-3603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOCK",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-31",
        "last_updated": "2016-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101015640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rayna Kaspar
• Kcmott LLC (Evergreen Therapy Group)
• Kenneth E. Vobach, M.D., P.C.
• William George Kinney Jr.
• Nevaeh Kissee
• Kevin Bruce Knickerbocker, MA, LPC
• Anilkumar Koshiya, MPT
• Kroger Co of Michigan (Kroger Pharmacy)
• Rebecca Lynn Kupper, MA, BCBA, LBA
• Terria Kurtz

• Family Medicine Physician in Davison, MI
• Providers in Davison, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.