NPIMap

Individual provider Active NPI

Jennifer Nicole Malicke, D.O.

  • Emergency Medicine Physician
  • Royal Oak, MI
National Provider Identifier
1891082905
Registry record updated Nov 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101019566 Issued in MI
Practice address
727 Royal Ave
Royal Oak, MI 48073-5704
Phone
(417) 718-0144
NPI assigned
Jul 9, 2011
Last updated
Nov 29, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5101019566 MI Primary

Addresses

Primary practice location

727 Royal Ave
Royal Oak, MI 48073-5704

Mailing address

727 Royal Ave
Royal Oak, MI 48073-5704
Phone (417) 718-0144

Other names 1

  • Jennifer Nicole Garner Former name

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
I20150324001762 MI Practitioner - Emergency Medicine 3870810294 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Kansas City College of Medicine and Surgery, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Vein Therapies PLLCGroup PAC ID 5496750523, 9 clinicians
Ecs Western Michigan PCGroup PAC ID 8628327384, 202 clinicians

Practice addresses (Care Compare)

25500 Meadowbrook Rd
Suite 215
Novi, MI 48375-1882
Phone (248) 344-9110

300 N Patterson Rd
Reed City, MI 49677-8041
Phone (231) 832-3271

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.48 of 100Reported as group
Quality
89.26
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101019566MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Observation Emergency Physicians, P.C. Emergency Medicine CurrentSince Jun 1, 2015 Accepting new patients
Visionary Medical Services PC Emergency Medicine CurrentSince Oct 7, 2023 Accepting new patients
Emergency Professionals of Michigan, P.C. Emergency Medicine CurrentSince Sep 1, 2016 Accepting new patients
Ecs Western Michigan PC Emergency Medicine CurrentSince Aug 1, 2018 Accepting new patients

Locations

7300 N Canton Center Rd
Canton, MI 48187
Phone (734) 454-8001

18101 Oakwood Blvd
Dearborn, MI 48124
Phone (313) 593-8780

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

1840 Wealthy St SE
Grand Rapids, MI 49506
Phone (616) 391-1730

615 S Bower St
Greenville, MI 48838
Phone (616) 754-4341

826 W King St
Owosso, MI 48867
Phone (989) 720-2273

300 N Patterson Rd
Reed City, MI 49677
Phone (231) 832-3271

11800 E 12 Mile Rd
Warren, MI 48093
Phone (586) 573-5000

Organizations & group practices 6

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 4

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": "1310169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417219200000",
    "number": "1891082905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "727 ROYAL AVE",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480735704",
            "telephone_number": "417-718-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 ROYAL AVE",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480735704",
            "telephone_number": "417-718-0144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALICKE",
        "first_name": "JENNIFER",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-09",
        "last_updated": "2014-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101019566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "GARNER",
            "middle_name": "NICOLE",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.