Phillip Wayne Jewell

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

16300 Woodward Ave
Highland Park, MI 48203-2882

Phone

(313) 365-7211

Fax

(313) 365-7211

NPI assigned

Aug 5, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Harvest Retreat Drop-in Center

  • Community/Behavioral Health Agency
  • Detroit, MI
  • NPI 1215470067
  NPD (past)

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

{
    "created_epoch": "1564963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564963200000",
    "number": "1922653286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21840 HARDING ST",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482372523",
            "telephone_number": "313-365-7211",
            "fax_number": "313-365-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16300 WOODWARD AVE",
            "city": "HIGHLAND PARK",
            "state": "MI",
            "postal_code": "482032882",
            "telephone_number": "313-365-7211",
            "fax_number": "313-365-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEWELL",
        "first_name": "PHILLIP",
        "middle_name": "WAYNE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-05",
        "last_updated": "2019-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roderick O. Jackson, C.P.S.S.
• Jagneswar Saha DO PC
• Jagneswar Saha DO PC
• Ashwani Jaiswal, M.D.
• Nathaniel Alexander Jean-Baptiste
• Johnnye Fayes Place
• Diane Johnson, MASTERS OF SCIENCE
• Jureka Johnson
• Kimberly Johnson
• Sebrina L Johnson, LPC

• Peer Specialist in Highland Park, MI
• Providers in Highland Park, MI by specialty
• Peer Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.