NPIMap

Individual provider Active NPI

Jordan Quilico, D.O.

  • Internal Medicine Physician
  • Tawas City, MI
National Provider Identifier
1942597547
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101019048 Issued in MI
Practice address
295 Maple St Ste 202
Tawas City, MI 48763-9352
Phone
(989) 362-6108
Fax
(989) 362-0161
NPI assigned
Jul 1, 2011
Last updated
Apr 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101019048 MI Primary

Addresses

Primary practice location

295 Maple St Ste 202
Tawas City, MI 48763-9352

Mailing address

PO Box 779
Tawas City, MI 48764-0779
Phone (989) 362-6108

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jordanquilico@smomsjhs.allscriptsdirect.net

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
I20160415002127 MI Practitioner - Internal Medicine 2264730738 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Osteopathic Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center TawasGroup PAC ID 9638070766, 36 clinicians
Mymichigan Medical GroupGroup PAC ID 4981501939, 174 clinicians
Progress Physical Therapy IncGroup PAC ID 5698669919, 23 clinicians

Practice addresses (Care Compare)

110 Beech St
Tawas City, MI 48763-8314
Phone (989) 362-9859

200 Hemlock Rd
Tawas City, MI 48763-2000
Phone (989) 839-1644

295 Maple St
Tawas City, MI 48763-9352

3076 Northridge Rd
Hale, MI 48739-9277
Phone (989) 728-0242

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Tawas Internal Medicine Current Accepting new patients
Mymichigan Medical Center Tawas Current Accepting new patients
Mymichigan Medical Center Tawas CurrentSince Nov 13, 2020 Accepting new patients
Schoolcraft Memorial Hospital CurrentSince Jul 1, 2019 Accepting new patients
Mymichigan Medical Center Tawas CurrentSince Nov 13, 2020 Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients

Locations

7870W US Highway 2
Manistique, MI 49854
Phone (906) 341-2153

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

805 W Cedar St
Standish, MI 48658
Phone (989) 846-3500

110 Beech St
Ste A
Tawas City, MI 48763
Phone (989) 362-0197

200 Hemlock Rd
Tawas City, MI 48763
Phone (989) 362-3411

200 Hemlock St
Tawas City, MI 48763
Phone (989) 362-0153

295 Maple St
Ste 202
Tawas City, MI 48763
Phone (989) 362-6108

325 E M 55
Ste B
Tawas City, MI 48763
Phone (989) 362-4626

Interoperability endpoints

  • Direct secure messaging: jordan.quilico.1@11016.direct.athenahealth.com
  • Direct secure messaging: jquilico@direct.dmc.org

Organizations & group practices 11

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1942597547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 779",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "487640779",
            "telephone_number": "989-362-6108",
            "fax_number": "989-362-0161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 MAPLE ST STE 202",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "487639352",
            "telephone_number": "989-362-6108",
            "fax_number": "989-362-0161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUILICO",
        "first_name": "JORDAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-01",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101019048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jordanquilico@smomsjhs.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "295 Maple St Ste 202",
            "city": "Tawas City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "487639352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tawas City, MI

Sources for this page

Verify at the official NPI Registry.