Active NPI
Jessica Jo Grace, M.D.
- Pediatrics Physician
- East China, MI
National Provider Identifier
1952490765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 4301082242
- Practice address
- 4154 S River Rd BLDG 2
East China, MI 48054-2930 - Phone
- (810) 329-6710
- Fax
- (810) 329-8790
- NPI assigned
- Oct 11, 2006
- 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 | 4301082242 | MI | Primary |
Addresses
Primary practice location
4154 S River Rd BLDG 2
East China, MI 48054-2930
Mailing address
4154 S River Rd BLDG 2
East China, MI 48054-2930
Phone (810) 329-6710
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952490765 | Medicaid | MI | |
| 4301082242 | Other | MI | PHYSICIAN LICENSE |
Other names 1
- Jessica Jo Hurley
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301082242 | MI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Water Children'S Health Care | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/22735/brand/1/csg/1/fhir/r4
- jgrace@bwchcp-mi.direct.office.nextgen.com
- https://fhir.meditouchehr.com/api/fhir/r4/
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557100800000",
"number": "1952490765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4154 S RIVER RD BLDG 2",
"city": "EAST CHINA",
"state": "MI",
"postal_code": "480542930",
"telephone_number": "810-329-6710",
"fax_number": "810-329-8790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4154 S RIVER RD BLDG 2",
"city": "EAST CHINA",
"state": "MI",
"postal_code": "480542930",
"telephone_number": "810-329-6710",
"fax_number": "810-329-8790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRACE",
"first_name": "JESSICA",
"middle_name": "JO",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-11",
"last_updated": "2019-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301082242",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1952490765",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIAN LICENSE",
"identifier": "4301082242",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "HURLEY",
"middle_name": "JO",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in East China, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.