Active NPI
Jessica Elizabeth Ezell, DO
- Pediatrics Physician
- Shelby TWP, MI
National Provider Identifier
1942943964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 5101028683
- Practice address
- 15125 22 Mile Rd
Shelby TWP, MI 48315-4406 - Phone
- (586) 532-0599
- NPI assigned
- Apr 18, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5101028683 | MI | Primary |
Addresses
Primary practice location
15125 22 Mile Rd
Shelby TWP, MI 48315-4406
Mailing address
46649 Greenbriar Dr
Chesterfield, MI 48051-2872
Phone (586) 292-0181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220524002601 | MI | Order and Referring Only - Pediatric Medicine | 1153708508 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101028683 | MI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shelby Pediatric Associates and Child Lung Center PC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- jessica.ezell.1@7131.direct.athenahealth.com
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Shelby Township, MI
- NPI 1124051990
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749600000000",
"number": "1942943964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46649 GREENBRIAR DR",
"city": "CHESTERFIELD",
"state": "MI",
"postal_code": "480512872",
"telephone_number": "586-292-0181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15125 22 MILE RD",
"city": "SHELBY TWP",
"state": "MI",
"postal_code": "483154406",
"telephone_number": "586-532-0599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZELL",
"first_name": "JESSICA",
"middle_name": "ELIZABETH",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-18",
"last_updated": "2025-06-11",
"certification_date": "2025-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "5101028683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelby TWP, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.