NPIMap

Individual provider Active NPI

Jill L Stephenson-McCole, MD

  • Family Medicine Physician
  • Holt, MI
National Provider Identifier
1831290402
Registry record updated Jul 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301093889 Issued in MI
Practice address
2040 Aurelius Rd
Holt, MI 48842-1367
Phone
(517) 694-2217
Fax
(517) 694-2655
NPI assigned
Sep 26, 2006
Last updated
Jul 31, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301093889 MI Primary

Addresses

Primary practice location

2040 Aurelius Rd
Holt, MI 48842-1367

Mailing address

PO Box 13008
Lansing, MI 48901-3008
Phone (517) 645-0000

Other identifiers 1

IdentifierTypeStateIssuer
13334867MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090819000523 MI Practitioner - Family Practice 3476589425 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2040 Aurelius Rd
Holt, MI 48842-1367
Phone (517) 694-2217

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301093889MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Edward W Sparrow Hospital Association Family Medicine CurrentSince Jan 15, 2013 Accepting new patients
Edward W. Sparrow Hospital Association Past Accepting new patients
Fairview Clinics Past Accepting new patients
Jay M. Wolkov DO PC Past Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

2040 Aurelius Rd
Holt, MI 48842
Phone (517) 694-2217

2040 Aurelius Rd
Ste 22
Holt, MI 48842
Phone (517) 244-8932

Interoperability endpoints

  • Direct secure messaging: jstephensonmccole1644@sparrowdirecthie.org

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375228800000",
    "number": "1831290402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13008",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489013008",
            "telephone_number": "517-645-0000",
            "fax_number": "517-645-4559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 AURELIUS RD",
            "city": "HOLT",
            "state": "MI",
            "postal_code": "488421367",
            "telephone_number": "517-694-2217",
            "fax_number": "517-694-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENSON-MCCOLE",
        "first_name": "JILL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2013-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301093889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13334867",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holt, MI

Sources for this page

Verify at the official NPI Registry.