Jessica Gross, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601010866 Issued in MI

Practice address

6089 W Maple Rd Ste 200
West Bloomfield, MI 48322-2286

Phone

(248) 851-1600

Fax

(248) 851-0421

NPI assigned

Sep 21, 2020

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 19, 2022 through Jan 19, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671235200000",
    "number": "1871109256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3758 GRIFFITH AVE APT SUITE",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480721439",
            "telephone_number": "248-930-6134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6089 W MAPLE RD STE 200",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483222286",
            "telephone_number": "248-851-1600",
            "fax_number": "248-851-0421"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6089 W Maple Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "West Bloomfield",
            "state": "MI",
            "postal_code": "483222286",
            "country_code": "US",
            "telephone_number": "248-851-1600",
            "fax_number": "248-851-0421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROSS",
        "first_name": "JESSICA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-21",
        "last_updated": "2022-12-17",
        "certification_date": "2022-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601010866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.