NPIMap

Individual provider Active NPI

John Alex Jansen Jr., MD

  • Emergency Medicine Physician
  • Canton, MI
National Provider Identifier
1962540419
Registry record updated May 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4301045424 Issued in MI
Practice address
7300 N Canton Center Rd
Emergency Medicine Department
Canton, MI 48187-1579
Phone
(734) 454-8002
Fax
(866) 250-6385
NPI assigned
Feb 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4301045424 MI Primary

Addresses

Primary practice location

7300 N Canton Center Rd
Emergency Medicine Department
Canton, MI 48187-1579

Mailing address

38935 Ann Arbor Rd
Credentialing/Payor Contacting
Livonia, MI 48150-3397
Phone (734) 805-0487

Other identifiers 1

IdentifierTypeStateIssuer
1962540419MedicaidMI

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
I20050516000467 MI Practitioner - Emergency Medicine 1355382896 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301045424MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Michigan Emergency Physicians, LLP Emergency Medicine CurrentSince Dec 22, 2012 Accepting new patients
Northern Michigan Emergency Physicians, LLP Emergency Medicine Current Accepting new patients
Northern Michigan Emergenc Physicians, LLP Emergency Medicine CurrentSince Dec 22, 2012 Accepting new patients
Michigan Em-I Medical Services, P.C. Past Accepting new patients
St John Macomb-Oakland Hospital Past Accepting new patients
Epmg of Michigan, P.C. Emergency Medicine PastSince Aug 4, 2024 Accepting new patients
Shorepointe Emergency Care Physicians PC Past Accepting new patients
Kalamazoo Emergency Associates, PLC Emergency Medicine Past Accepting new patients
Depot Emergency Physicians Emergency Medicine Past Accepting new patients
Sturgis Emergency Physicians PLLC Emergency Medicine Past Accepting new patients

Locations

2463 S M 30
West Branch, MI 48661
Phone (517) 345-3660

Organizations & group practices 10

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": "1170547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274400000000",
    "number": "1962540419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38935 ANN ARBOR RD",
            "address_2": "CREDENTIALING/PAYOR CONTACTING",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481503397",
            "telephone_number": "734-805-0487",
            "fax_number": "866-250-6385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 N CANTON CENTER RD",
            "address_2": "EMERGENCY MEDICINE DEPARTMENT",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481871579",
            "telephone_number": "734-454-8002",
            "fax_number": "866-250-6385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANSEN",
        "first_name": "JOHN",
        "middle_name": "ALEX",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-04",
        "last_updated": "2010-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301045424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962540419",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

Verify at the official NPI Registry.