Jacob Russell Bryde, DNP, AGPCNP-BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

4704335991 Issued in MI

Practice address

804 Service Rd Ste A110
East Lansing, MI 48824-7015

Phone

(517) 353-2822

Fax

(517) 355-2824

NPI assigned

Jul 20, 2024

Sex

Male

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Powerback Rehabilitation LLC 600 clinicians

Msu Health Care Inc. 201 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230
• McLaren Greater Lansing Hospital, Lansing, MI, CCN 230167
• Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053
• Henry Ford Allegiance Health Hospital, Jackson, MI, CCN 230092

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacob.bryde.1@25394.direct.athenahealth.com

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.

• Msu Health Care Inc

  • Allergy & Immunology Physician
  • East Lansing, MI
  • NPI 1700418670

  MI

  Medicare reassignment Care Compare group NPD
• Msu Health Care Inc.

  • Physical Therapist
  • East Lansing, MI
  • NPI 1689206419
  Care Compare group NPD
• Msu Health Care Inc.

  • Diagnostic Radiology Physician
  • East Lansing, MI
  • NPI 1275165052
  Care Compare group
• Msu Health Care Inc.

  • Institutional Pharmacy
  • East Lansing, MI
  • NPI 1467083485
  Care Compare group
• Msu Health Care Inc

  • Family Medicine Physician
  • East Lansing, MI
  • NPI 1316572134
  NPD
• Msu Health Care Inc.

  • Neurology Physician
  • East Lansing, MI
  • NPI 1053943928
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Edward W Sparrow Hospital Association

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1073588711

  Hospital

  Care Compare affiliation
• Edward W Sparrow Hospital Association

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1760710719

  Hospital

  Care Compare affiliation
• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801

  Hospital

  Care Compare affiliation
• McLaren Greater Lansing

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1134104672

  Hospital

  Care Compare affiliation
• W.a. Foote Memorial Hospital

  • General Acute Care Hospital
  • Jackson, MI
  • NPI 1053403402

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1721433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1821836024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A202",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-355-2822",
            "fax_number": "517-355-2824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A110",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-353-2822",
            "fax_number": "517-355-2824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYDE",
        "first_name": "JACOB",
        "middle_name": "RUSSELL",
        "credential": "DNP, AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-20",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704335991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamara Ann Brown, R.N.
• Theresa Ann Brown, LMSW
• Emily Brundage, LMSW
• Rachael Phoebe Brunger, LLPC
• Susan Bryant, M.A.,CCC-A
• Nicole Therese Buchanan, PH.D.
• Cynthia A. Buchweitz, MD
• Karah Bucknam
• Colin Buday, DO
• Rebecca Budde

• All providers in East Lansing, MI
• Gerontology Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.