NPIMap

Organization Active NPI

Endovascular Center of America PLLC

  • Vascular Surgery Physician
  • Jackson, MI
National Provider Identifier
1962092213
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
ENDOVASCULAR CENTER OF AMERICA PLLC
Practice address
205 Page Ave Ste a
Jackson, MI 49201-2462
Phone
(517) 787-3577
NPI assigned
Jan 21, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Authorized official

Name
Tareq Baghal, MD
Title
Owner
Phone
(517) 787-3577

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

205 Page Ave Ste a
Jackson, MI 49201-2462

Mailing address

205 Page Ave Ste a
Jackson, MI 49201-2462
Phone (517) 787-3577

National Provider Directory

National Provider Directory

Locations

205 Page Ave
Ste A
Jackson, MI 49201
Phone (517) 787-3577

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1962092213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 PAGE AVE STE A",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012462",
            "telephone_number": "517-787-3577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 PAGE AVE STE A",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012462",
            "telephone_number": "517-787-3577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDOVASCULAR CENTER OF AMERICA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "BAGHAL",
        "authorized_official_first_name": "TAREQ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-787-3577",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; 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.